Public Health Measures and Strategies to Limit the Spread of COVID-19: an International Review [V10.0]

Public health measures and strategies to limit the spread of COVID-19: an international review [v10.0]

Item Type Report

Authors Health Information and Quality Authority (HIQA)

Publisher Health Information and Quality Authority (HIQA)

Download date 30/09/2021 15:57:22

Link to Item http://hdl.handle.net/10147/628768

Find this and similar works at - http://www.lenus.ie/hse Public health measures and strategies to limit the spread of COVID-19 Health Information and Quality Authority

Public health measures and strategies to limit the spread of COVID-19: an international review

Update submitted to NPHET: 20 April 2021 Published: 26 April 2021

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Public health measures and strategies to limit the spread of COVID-19 Health Information and Quality Authority Version history

Version Date Specific updates V1.0 24 November 2020 Provided to the National Public Health Emergency Team (NPHET) for information. V2.0 1 December 2020 Updated and provided to NPHET for information. . Included an additional table (Table 2) to summarise the recent changes in current public health measures. . Updated the epidemiological data to the latest available data from the European Centre for Disease Prevention and Control (ECDC). . Included information on the proposed plans for mass testing in Austria. V3.0 8 December 2020 Updated and provided to NPHET for information. . Updated the epidemiological data to the latest available data from the European Centre for Disease Prevention and Control (ECDC). V4.0 15 December 2020 Updated and provided to NPHET for information. . Updated the epidemiological data to the latest available data from the European Centre for Disease Prevention and Control (ECDC). V5.0 23 December 2020 Updated and provided to NPHET for information. . Reduced version of report created with updated public health measures on education only. V6.0 06 January 2021 Updated and provided to NPHET for information.

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. Included information on the current epidemiological situation in each country. . Updated the education public health measures only. V7.0 3 February 2021 Updated and provided to NPHET for information. . Included updated information on antigen testing in asymptomatic individuals in community settings only. V8.0 10 February 2021 Updated and provided to NPHET for information. . Included information on the current epidemiological situation in each country. . Included updated information on antigen testing in asymptomatic individuals in community settings only. V9.0 16 March 2021 Updated and provided to NPHET for discussion. . Included information on the current epidemiological situation in each country and vaccination roll out. . Included Israel. . Excluded measures relating to international travel. . Excluded contact tracing section. V10.0 20 April 2021 Updated and provided to NPHET for discussion. . Included information on the current epidemiological situation in each country and vaccination roll out. . Included Israel, Finland and Norway. . Excluded Switzerland. . Excluded measures relating to international travel and face coverings. . Excluded contact tracing section.

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Public health measures and strategies to limit the spread of COVID-19 Health Information and Quality Authority About the Health Information and Quality Authority

The Health Information and Quality Authority (HIQA) is an independent statutory authority established to promote safety and quality in the provision of health and social care services for the benefit of the health and welfare of the public.

HIQA’s mandate to date extends across a wide range of public, private and voluntary sector services. Reporting to the Minister for Health and engaging with the Minister for Children, Equality, Disability, Integration and Youth, HIQA has responsibility for the following:

. Setting standards for health and social care services — Developing person-centred standards and guidance, based on evidence and international best practice, for health and social care services in Ireland.

. Regulating social care services — The Chief Inspector within HIQA is responsible for registering and inspecting residential services for older people and people with a disability, and children’s special care units.

. Regulating health services — Regulating medical exposure to ionising radiation.

. Monitoring services — Monitoring the safety and quality of health services and children’s social services, and investigating as necessary serious concerns about the health and welfare of people who use these services.

. Health technology assessment — Evaluating the clinical and cost- effectiveness of health programmes, policies, medicines, medical equipment, diagnostic and surgical techniques, health promotion and protection activities, and providing advice to enable the best use of resources and the best outcomes for people who use our health service.

. Health information — Advising on the efficient and secure collection and sharing of health information, setting standards, evaluating information resources and publishing information on the delivery and performance of Ireland’s health and social care services.

. National Care Experience Programme — Carrying out national service- user experience surveys across a range of health services, in conjunction with the Department of Health and the HSE.

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Public health measures and strategies to limit the spread of COVID-19 Health Information and Quality Authority Contents

Version history ...... 2 About the Health Information and Quality Authority ...... 4 Contents ...... 5 Key points ...... 6 1 Background ...... 10 2 Methods ...... 10 3 Findings ...... 12 3.1 Summary epidemiological data ...... 12 3.1.1 Vaccine rollout progress ...... 14 3.2 Public health frameworks for living with COVID-19...... 18 3.3 Current public health measures ...... 21 3.3.1 Movement of people ...... 25 3.3.2 Social or mass gatherings ...... 25 3.3.3 Places of worship/religious services ...... 25 3.3.4 Education ...... 26 3.3.5 Domestic travel (including transport) ...... 27 3.3.6 Culture/leisure/entertainment ...... 27 3.3.7 Sporting/recreational activities (amateur and professional) ...... 28 3.4 Testing strategies ...... 29 3.4.1 International testing strategies ...... 29 4 Conclusion ...... 31 References ...... 107 Appendix A – Latest summary epidemiological data by country ...... 120 Appendix B – Developed frameworks for living with COVID-19 by country ...... 121 Appendix C – International testing strategies ...... 145

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Public health measures and strategies to limit the spread of COVID-19 Health Information and Quality Authority Key points

. Based on data up to 18 April 2021, when compared with the previous seven days, the 14-day incidence rate of new cases per 100,000 population: o increased in five of the included countries: Sweden (up 12.4% [860.9 per 100,000 population]), the Netherlands (1.5% [609.4]), Germany (13.9% [309.4]), Spain (15.3% [227.4]), and Portugal (8.2% [75.2]). o decreased in 11 of the of the included countries: France (down 9.0% [685.8 per 100,000 population]), Czechia (23.3% [466.8]), Belgium (10.5% [422.8]), Austria (14.5% [384.9], Italy (15.1% [333.9]), Norway (15.6% [163.0]), Denmark (4.7% [160.8]), Ireland (16.3% [108.6]), Finland (21.7% [85.5]), the UK (22.2% [43.1]) and Israel (30.2% [32.3]).

. Most countries experienced an increase in the 14-day death rate per million population subsequent to a surge in cases in December 2020/January 2021. The death rate has since fallen across the majority of countries. However, a small number of countries including Austria (up 4.2% [49.9 per million population]), Germany (17.7% [35.7]), Sweden (32.4% [28.7], and Norway (25.0% [6.5]) have seen an increase in the 14-day death rate over the previous seven days (up to 18 April 2021). The rate remained broadly unchanged over the previous seven days in Belgium and Ireland at approximately 50 and 24 per million population, respectively.

. The impact of the increase in COVID-19 cases has also been observed through increased hospitalisations and admissions to intensive care: o Since January 2021, hospitalisations and admissions to intensive care have been highest in Czechia and Portugal; hospitalisations surpassed 600 per million population in these countries in February 2020, while admissions to intensive care surpassed 80 per million population in the same month. o While the rate of hospitalisations has since dropped to below 50 in Portugal [45.7 per million population] and in a number of other countries, the rate on 11 April remained high in Italy (510.0), Czechia (490.1), and France (450.1). The rate has increased over the previous seven days in France (up 4.5% [450.1]), Belgium (5.5% [266.2]), Sweden (9.4% [204.9]), Austria (2.0% [189.3], and the Netherlands (8.9% [100.9]). o A similar increasing trend has been observed in the rate of admissions to intensive care in these countries over the previous seven days, as well as in Germany (up 12.8% [54.5 per million population]). In Ireland, the rate of hospitalisations and admissions to intensive care decreased over the

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previous seven days (up to 11 April) by 12.0% (43.1 per million population) and 8.6% (10.7), respectively.

. Based on data up to 11 April 2021, the test positivity rate has continued to trend downwards in a number of countries. Over the previous seven days, the share of tests returned as positive declined in Italy (down 15.3% [to 5.0% test positivity]), Norway (down 23.3% [to 2.7%]), Czechia (down 23.0% [to 2.6%]), Ireland (down 16.5% [to 2.6%]), Finland (down 19.0% [to 2.2%]), Portugal (down 26.4% [to 1.2%]), Austria (down 11.2% [to 0.9%]), and Denmark (down 33.7% [to 0.2%]). However, the positivity rate increased over the previous seven days in Sweden (up 7.2% [to 13.0% test positivity]), Germany (up 6.8% [to 10.2%]), the Netherlands (up 12.6% [to 9.6%]), France (up 15.9% [to 9.1%]), Belgium (up 18.2% [to 8.5%]), and Spain (up 16.0% [to 7.4%]).

. Each of the included countries has launched a COVID-19 vaccination programme. Based on data up to 13 April 2021: o Israel (118.9) and the UK (59.6) had the highest reported number of vaccine doses (counted as a single dose) administered per 100 population of the included countries. In all other countries, the rate was approximately 20-25 per 100 people. o As a share of the population, 57.3% were fully vaccinated in Israel, while 12.0% of the population in the UK were fully vaccinated against COVID-19. Denmark (8.1%) had the next highest share of the population fully vaccinated, while in Ireland, 6.4% of the population were fully vaccinated.

. A number of jurisdictions, including Austria, Belgium, Czechia, Denmark, England, Finland, France, Israel, Ireland, Italy, Netherlands, Norway, Portugal, Spain, Scotland and Wales have developed frameworks or systems for living with COVID-19. They are used to assess the level of risk associated with the virus and the level of public health measures, or restrictions, that are needed to contain it.

. A number of countries, including but not limited to, England, Finland, Germany, Norway, Northern Ireland, Portugal, Wales and Scotland, have also updated their frameworks and published plans for a gradual easing of restrictions. The plans contain a number of stages, with specified time intervals between stages to enable an assessment of the situation before moving to the next phase.

. To guide decision-making on public health measures, a variety of epidemiological parameters are being monitored internationally including the 14-day incidence of COVID-19 cases per 100,000 population, mortality rate and test positivity rate. Decisions to escalate or de-escalate public health measures

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also take hospital statistics into consideration, which may lag behind changes in the incidence of the disease.

. More recently, other factors including the number of people who have been vaccinated, emerging information on variants of concern and evidence in relation to vaccine effectiveness, are also being considered when making decisions in relation to restrictive measures.

. Internationally, public health restrictions have been applied at different levels. Some jurisdictions are applying restrictions at a nationwide level, (for example, England, Ireland, the Netherlands, Portugal and Wales), some at a nationwide level with additional regional restrictions (for example France, Norway and Spain), while others are doing so at a regional or municipal level only (for example, Finland, Israel and Italy).

. In those countries with a published risk framework, with the exception of England, Finland, Israel, Italy and Norway, all are still operating at either the highest risk level of their individual framework or the majority of regions in the country are at the highest risk level, with corresponding restrictive measures in place. The situation continues to remain extremely fluid with restrictive measures under constant review across Europe.

. Easing of restrictions has commenced in Israel and a ‘Green Pass’ system has been introduced for those who are fully vaccinated and those who have recovered from COVID-19. Establishments that comply with the ‘Green Pass’ restrictions have less restrictive measures than those without and holders of a ‘Green Pass’ can access these establishments. Similarly, ‘Corona Passes’ are being implemented in Denmark to facilitate easing of certain measures.

. A gradual easing of restrictions has commenced or continued within the past few weeks in the majority of included countries. However, for two countries, although measures were generally eased, they were extended in specific regions with high incidence (Austria and Belgium). Three countries extended restrictions nationally (France, Germany and Sweden) in light of deteriorating epidemiological indicators. No change in measures were observed in Spain during this time period. The majority of included countries have published, or have signalled their intention to publish, a roadmap for easing restrictions.

. While the type of measures that have been applied are generally consistent across countries, the detail varies considerably particularly in terms of restriction on movement (for example curfews are in place in some countries), numbers permitted at gatherings and events and the operating hours of businesses within the hospitality sector.

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. Ireland is one of the few included countries (along with the UK and Spain) where all primary and secondary schools have fully reopened for face-to-face teaching, regardless of local or regional restrictions, as of 16 April 2021.

. As a national strategy, individuals displaying symptoms consistent with COVID- 19 are prioritised for testing in each of the countries included in this review. In Austria, Czechia, Denmark, England, France, Germany, Israel and Portugal. However, testing is provided for anyone that requests a test, irrespective of the presence of symptoms.

. Fifteen of the 19 included countries have expanded testing to also include screening of asymptomatic individuals in certain settings (for example, serial testing of staff and residents in residential care facilities).

. Population-wide testing has been implemented in Austria and Czechia, while Germany, Ireland, Norway, Portugal, Sweden (some regions) and the UK (all four jurisdictions) have a strategy to implement regional or community wide asymptomatic testing in a range of settings including walk-in testing centres, workplaces and schools in the event of an increased incidence or in high risk communities.

. Rapid antigen tests are available in all countries. Testing based on either unsupervised self-test (sample and test processing by patient) or self-sampling (sample collected by patient, but test processed by trained staff) is in use in Austria, Czechia, England, Germany, Portugal, Scotland, Sweden and Wales, with a pilot currently underway in the Netherlands.

. The information relating to public health measures and testing strategies included in this international review is correct as of 16 April 2021, but may be subject to change.

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Public health measures and strategies to limit the spread of COVID-19 Health Information and Quality Authority 1 Background

Since the onset of the coronavirus disease 2019 (COVID-19) pandemic in early 2020, governments across the globe have applied restrictive public health policy measures, or non-pharmaceutical interventions, at various stages, and with different levels of intensity, to reduce or slow down transmission of the virus. National testing strategies have been developed to identify cases of COVID-19 in symptomatic individuals and expanded over the course of the pandemic to identify and isolate asymptomatic cases through preventive screening programmes. Mass testing programmes have also been implemented to rapidly identify and isolate cases in high-risk areas, for example, as well as across populations. The Health Information and Quality Authority’s (HIQA’s) Health Technology Assessment (HTA) Team has been requested by the National Public Health Emergency Team (NPHET) to review the public health measures and strategies that are being used internationally to limit the spread of COVID-19.

2 Methods

A detailed summary of the methods used for this review is provided in the protocol: Public health measures and strategies to limit the spread of COVID-19: an international review, available on www.hiqa.ie. Briefly, the review focuses on the national response to COVID-19 in 19 countries that were identified by NPHET as being in a similar phase of pandemic response as Ireland. The countries comprise 13 EU countries (Austria, Belgium, Czechia, Denmark, Finland, France, Germany, Ireland, Italy, Netherlands, Portugal, Spain, Sweden), the UK (England, Northern Ireland, Scotland and Wales), as well as Israel and Norway.

A number of key epidemiological parameters were extracted as part of the review for the purposes of describing the current epidemiological situation in each country. The data were sourced directly from the European Centre for Disease Prevention and Control (ECDC)(1) and Our World in Data (OWID),(2) which is produced by the Oxford Martin School at the University of Oxford and the Global Change Data Lab (A UK- based charity in the education sector). Since the data for the UK are aggregated, a breakdown of the epidemiological data by country is not provided. The epidemiological parameters include the:

. 14-day notification rate of newly reported COVID-19 cases per 100,000 population(2) . 14-day notification rate of newly reported COVID-19 deaths per million population(2)

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. daily hospital occupancy rate (number of COVID-19 patients in hospital on a given day per million population; sourced from OWID, based on ECDC)(2) . daily intensive care unit (ICU) occupancy rate (number of COVID-19 patients in ICU on a given day per million population; sourced from OWID, based on ECDC)(2) . weekly number of tests performed per 100,000 population(1) . percentage of COVID-19 tests performed weekly that are positive(1) . total number of vaccination doses (counted as a single dose) administered per 100 people(2) . share of the population that have been fully vaccinated (received two doses) against COVID-19.(2) Information on public health measures (that is, restrictive measures or non- pharmaceutical interventions) that are currently in place to limit the spread of COVID-19 was sought from government resources. The public health measures of interest include those related to:

. movement of people (for example, stay at home measures or curfews) . social or mass gatherings . education . business activities . sporting activities . religious activities . domestic travel . extended use of face coverings Measures relating to extended use of face coverings have been excluded for this update. Where countries have developed detailed frameworks for living with COVID-19 at varying levels of community transmission, for example, this information was extracted, alongside any criteria that are being used to inform a change in public health measures, or level of restrictions. Finally, details of national testing strategies were extracted for each country to provide information on the extent that these measures are being used to quickly identify and isolate cases of COVID-19.

The review was first undertaken on 24 November. Regular updates will be provided, as required by NPHET.

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Public health measures and strategies to limit the spread of COVID-19 Health Information and Quality Authority 3 Findings

This section summarises the international public policy response to COVID-19.

. Section 3.1 presents an overview of the current epidemiological situation in each country: o Table 1 summarises the vaccine rollout progress in each country o Appendix A provides a detailed breakdown of the latest epidemiological data and weekly percentage change by country. . Section 3.2 describes the frameworks that have been developed for living with COVID-19, alongside the criteria that are being used to guide decision- making on public health measures: o Appendix B provides a detailed summary of the frameworks and criteria by country. . Section 3.3 presents a summary of the current public health measures that are in place in each country: o Table 2 summarises the current risk levels for each country. o Table 3 catalogues the different public health measures by country. . Section 3.4 presents an overview of the testing strategies that are being used to interrupt the transmission of COVID-19: o Appendix C details each country’s approach to testing. 3.1 Summary epidemiological data

Although most countries experienced a reduction in the incidence of coronavirus cases in early 2021 (following a surge in new cases in December (2020)/January (2021)) through increased public health measures (or restrictions), some countries have been experiencing an increase in the 14-day incidence rate of new cases (Figure 1a). As of 18 April, over the previous seven days, the 14-day incidence rate increased in Spain (representing a 15.3% week-on-week increase), Germany (13.9%), Sweden (12.4%), Portugal (8.2%), and Netherlands (1.5%) (see Appendix A for a detailed breakdown of the weekly percentage change in the 14-day incidence by country, along with the associated epidemiological data). Of these countries, the 14-day incidence rate was highest in Sweden, at approximately 860 per 100,000 population. The 14-day incidence rate was also high in France on 18 April at 686 per 100,000 population, however, the rate declined over the previous seven days by 9.0%. The incidence rate also declined over the previous seven days in Israel (30.2%), Czechia (23.3%), the UK (22.2%), Finland (21.7%), Ireland (16.3%), Norway (15.6%), Italy (15.1%), Austria, (14.5%), Belgium (10.5%), and Denmark (4.7%). On 18 April, the 14-day incidence rate was lowest in Israel and the UK at 32.3 and 43.1 per 100,000 population, respectively, likely reflecting the extent of the vaccine rollout in these countries (see Table 1 – further details provided below also).

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In Ireland, the 14-day incidence rate was 108.6 per 100,000 population on the same date.

Following on from the latest surge in cases, most countries experienced a corresponding increase in the 14-day death rate per million population (Figure 1b). Since January 2021, the highest rates were observed in Czechia, Portugal, and the UK. At its peak in Portugal on 5 February, the 14-day death rate reached 375 per million population. In the UK, the death rate reached 253 on 27 January. In Czechia, the death rate initially peaked at 223 on 19 January before falling and rising again to 281 on 19 March. While the death rate has since fallen to 138 per million population in Czechia, it remains the highest of any of the included countries. In Portugal and the UK, the death rate has since dropped to 6.5 per million population in each country, which was only slightly higher than Denmark, which had the lowest rate at 4.5 per million population on 18 April. The latest data also show that the death rate was falling across the majority of countries. However, over the previous seven days the 14-day death rate increased in Sweden (32.4%), Norway (25.0%), Germany (17.7%), and Austria (4.2%). The rate remained broadly unchanged over the previous seven days in Belgium and Ireland at approximately 50 and 24 per million population, respectively (Appendix A).

The impact of the most recent increase in cases can also be observed in the numbers of people in hospital (Figure 2a) and intensive care (Figure 2b) due to COVID-19, which increased substantially across most countries since January 2021. In Czechia and Portugal, the rate of hospitalisations surpassed 600 per million population in February, while in France, Ireland, Italy, and the UK, the rate surpassed 400. In most countries however, the rate of hospitalisations has fallen considerably since February. As of 11 April, the rate of hospitalisations was below 50 per million population in a number of countries, including Ireland where the rate was 43.1 per million population. In contrast, the numbers remained high in Italy (510.0), Czechia (490.1), and France (450.1), and increased in France (4.5%) over the previous seven days. An increase in the hospitalisation rate was also observed in Sweden (9.4%), the Netherlands (8.9%), Belgium (5.5%), and Austria (2.0%) (Appendix A).

A similar trend was observed in the numbers admitted to intensive care since January 2021. Although the rate recently fell to below 20 per million population in some countries (for example, Denmark, Finland, Ireland, Israel, Portugal, and the UK) a number of countries have seen an increase in the rate of admissions to intensive care over the previous seven days (as of 11 April) including in Sweden (13.7%), Germany (12.8%), Austria (6.6%), France (9.3%), Belgium (8.2%), and the Netherlands (7.9%) (Appendix A). Czechia remains the worst affected of the included countries with 110.4 people per million population in ICU. In Ireland, the

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Public health measures and strategies to limit the spread of COVID-19 Health Information and Quality Authority rate of hospitalisations and admissions to intensive care decreased over the previous seven days (up to 11 April) by 12.0% (43.1 per million population) and 8.6% (10.7), respectively.

Figure 3a presents the weekly number of tests performed per 100,000 population in each country, while Figure 3b presents the test positivity rate (that is the share of tests performed weekly that are positive). Based on the latest available data from the ECDC,(1) which includes both RT-PCR and antigen tests, weekly testing per 100,000 population ranged from 1,386 in Germany to 45,255 in Denmark, with Ireland at 2,193 per 100,000 population. In a number of countries, the test positivity rate continued to trend downwards on 11 April, following the latest wave of coronavirus cases. Over the previous seven days, the share of tests returned as positive declined in Italy (down 15.3% [to 5.0% test positivity]), Norway (down 23.3% [to 2.7%]), Czechia (down 23.0% [to 2.6%]), Ireland (down 16.5% [to 2.6%]), Finland (down 19.0% [to 2.2%]), Portugal (down 26.4% [to 1.2%]), Austria (down 11.2% [to 0.9%]), and Denmark (down 33.7% [to 0.2%]). However, the positivity rate increased over the previous seven days in Sweden (up 7.2% [to 13.0% test positivity]), Germany (up 6.8% [to 10.2%]), the Netherlands (up 12.6% [to 9.6%]), France (up 15.9% [to 9.1%]), Belgium (up 18.2% [to 8.5%]), and Spain (up 16.0% [to 7.4%]). It is important to note that the hospital activity and testing data are not up-to-date; the latest data from the ECDC were published on 15 April 2021 and reflect activity up to 11 April (or week 14 of 2021). In addition, it is important to note that cross- country comparisons of the testing data, including test positivity, are difficult due to changes in testing criteria over time, as well as variations in the way countries define ‘tests performed’ (for example, the unit may refer to the number of tests performed or the number of people tested).

3.1.1 Vaccine rollout progress A COVID-19 vaccine programme has been launched in each of the included countries. As detailed in Table 1, Israel and the UK had the highest reported number of vaccine doses (counted as a single dose) administered per 100 population of the included countries, up to 13 April 2021. In Israel, 118.9 vaccines were administered per 100 population, while in the UK, 59.6 vaccine doses were administered per 100 population. In all other countries, the rate was approximately 20-25 per 100 people; in Ireland 21.8 vaccine doses were administered per 100 population. As a share of the population, 57.3% were fully vaccinated in Israel on 13 April, while 12.0% of the population in the UK were vaccinated on the same date. Next to the UK, Denmark (8.1%) had the highest share of the population fully vaccinated up to 13 April 2021. In Ireland, 6.4% of the population were fully vaccinated. Finland had the lowest share of the population fully vaccinated on 13 April 2021, with approximately 2% fully vaccinated against COVID-19.

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Figure 1 14-day notification rate of new cases (1a) and deaths (1b) per 100,000 and million population, respectively (1 October 2020 to 18 April 2021)

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Figure 2 Daily number of people in hospital (2a) and ICU (2b) per million population (1 October 2020 to 11 April 2021)

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Figure 3 Weekly number of tests performed per 100,000 population (3a) and % of tests performed that are positive (3b) (1 October 2020 to 11 April 2021)

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Table 1 Total number of vaccination doses administered per 100 people in the total population and share of population fully vaccinated on 13 April 2021 Country Total number of vaccine Share of doses administered / population fully 100 people* vaccinated (weekly % change) (weekly % change) EU/EEA Austria 24.4 (19.9%) 7.2% (25.2%) Belgium 22.7 (20.3%) 5.5% (8.0%) Czechia 20.7 (18.2%) 7.2% (25.4%) Denmark 25.3 (20.1%) 8.1% (12.5%) Finland 23.3 (15.6%) 1.9% (14.8%) France 22.5 (19.4%) 5.8% (23.2%) Germany 23.0 (22.3%) 6.2% (11.1%) Ireland [12-Apr-21] 21.8 (14.4%) 6.4% (16.1%) Italy 22.6 (17.6%) 6.7% (13.5%) Netherlands [11-Apr-21] 22.1 (32.1%) 4.8% (2.3%) Norway 22.0 (17.8%) 5.5% (3.2%) Portugal 22.1 (16.0%) 6.2% (8.4%) Spain 23.7 (23.4%) 6.7% (8.1%) Sweden [14-Apr-21] 21.5† 6.2%† Non-EU Israel 118.9 (1.3%) 57.3% (1.5%) United Kingdom 59.6 (8.0%) 12.0% (43.8%) Source: OWID * Counted as a single dose and may not equal the total number of people vaccinated † No data available seven days earlier to calculate weekly percentage change

3.2 Public health frameworks for living with COVID-19

A number of countries have developed frameworks or systems for living with COVID- 19, which assess the current level of risk associated with the virus and the type of public health measures, or restrictions, that are needed to contain the virus. For example, in Ireland, a framework for restrictive measures in response to COVID-19 was developed to ensure an appropriate public health response could be implemented at different levels of community transmission. The framework is a constituent part of Resilience and Recovery 2020 to 2021; plan for living with COVID-19.(3) The framework consists of five levels of public health measures: Level 1 is the lowest level and has the fewest restrictions (low risk of transmission), while Level 5 is the highest level and has the most restrictions (reflecting widespread community transmission).(3)

Other countries that have also developed a public health framework for assessing the level of risk associated with COVID-19 and the type of national response that is

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Public health measures and strategies to limit the spread of COVID-19 Health Information and Quality Authority needed to contain that risk include Austria,(4) Belgium,(5) Czechia,(6) Denmark,(7) England,(8), Finland(9), Italy,(10) Norway,(11) Netherlands,(12) Portugal,(13) Spain,(14) Scotland,(15) Wales(16) and Israel.(17) Previously in Italy, regions were classified as Yellow (moderate), Orange (medium-high) or Red (high) risk areas, whereby a different set of restrictive measures was applied to each category. This framework has since been updated with the addition of White risk areas added to the framework. In areas classified as White, there will be no restrictions.(18) No region is currently classified as White. Austria has taken a similar ‘traffic light’ approach. All of Austria, individual federal states, individual districts or regions may be classified as Green (low-risk), Yellow (medium-risk), Orange (high-risk) or Red (very-high risk), whereby a different set of restrictive measures are applied to each category.(19) The frameworks developed in Czechia(20) and Denmark(21) are similar to that of Ireland, in that they also have five levels ranging from Level 1 to Level 5 with Level 1 being the least restrictive and Level 5 being the most. In Finland, a framework for living with COVID-19 referred to as the ‘Hybrid plan’ was developed for the period between January and May 2021.(9) Under this plan there are three levels or phases associated with varying levels of risk. The Basic level is associated with low incidence of infection, the Acceleration phase occurs when the regional incidence of cases has increased, while the Dissemination phase (or Community Transmission phase) occurs when the growth of the epidemic continues to accelerate and cases are spread regionally or more widely in the population. The least restrictive measures are implemented at the Basic level with the most restrictive being implemented at the Dissemination/Community transmission phase.

In Norway,(22) a three level system of regional measures is in place; Level A, Level B and Level C. These regional measures can be imposed on top of more general national measures. Level A encompasses particularly strict measures, while Level C encompasses much less strict measures. Additionally, local municipalities can apply even stricter measures than those indicated nationally or regionally. The government can decide which measures are to be implemented in a municipality and surrounding municipalities in the event of an outbreak of infection. It will always be the most stringent measures introduced in an area (i.e. local, regional, and national) that apply.

There is no evidence that a public health framework for living with COVID-19 has been developed in France, Germany, Northern Ireland or Sweden; however, each country has implemented public health measures to limit the spread of COVID-19, as detailed in section 3.3.

To inform a change in alert levels, or public health measures, a variety of triggers appear to be taken into consideration across the different countries. Some of the key

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Public health measures and strategies to limit the spread of COVID-19 Health Information and Quality Authority epidemiological parameters that are evaluated to influence a change in public health measures include, but are not limited to:

. the 14-day incidence of COVID-19 per 100,000 population . the incidence of COVID-19 per 100,000 population for particular age groups . the number of COVID-19 deaths . testing data (including the number of COVID-19 tests administered and the percentage of COVID-19 tests that are returned as positive) . the number of outbreaks . the nature and types of outbreaks . the source of clusters . estimates of the reproductive number . and the impact on vulnerable groups. Any decision to escalate or de-escalate public health measures also requires careful consideration of hospital statistics, which may lag behind a change in the incidence of the disease. For example, while the number of new infections may be declining, the healthcare sector may still be dealing with large numbers of patients recovering with COVID-19. As such, consideration is also given to available hospital and ICU bed capacity, for example. Information in relation to vaccinations is also now being collated across all countries, and is also one of the many relevant factors when considering a change in public health measures.

The majority of included countries have published, or have signalled their intention to publish, a roadmap for easing restrictions. In February 2021, England published a ‘COVID-19 Response – Spring 2021’ report which details a four step plan for reopening.(23) The first step of this plan commenced on 8 March, while the fourth step of this plan is set to be implemented no earlier than 21 June. In a similar way, the Northern Ireland Executive has published a guidance document detailing a pathway out of restrictions.(24) From the 23 April, some restrictions in relation to outdoor gatherings are set to be eased and close contact services can reopen. These are just some of the restrictions that will be lifted with more easing of restrictions set to follow on 30 April (including outdoor hospitality) and 24 May (including indoor hospitality). The easing of these restrictions are subject to ongoing review.(25) Scotland has also published an updated framework which detailed plans for a gradual easing of restrictions with a minimum three week gap between each phase of reopening.(26) Since then, the Scottish Government have announced a plan to accelerate the easing of some restrictions.(27) In March, Portugal published their ‘Plan for Easing’ whereby they have proposed four phases for easing restrictive measures.(28) In this plan it has been proposed to ease restrictive measures every 15 days between the period of 15 March and 3 May. However, not all restrictions will be eased as of 3 May and further details of the plan are to be provided in due course.

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The Finnish Government published a plan to lift restrictions; the report details a brief summary of restrictions that are expected to be lifted in April, May and June if both the epidemic situation permits and vaccination targets are met.(29) On 10 April, Norway published a 4-step reopening plan, with each step more restrictions will be eased. It was noted that a progression to a less restrictive step will be driven by data and not specific dates.(30) Denmark are also taking a similar approach and plan to reopen in 4 phases with Phase 1 commencing from 6 April and Phase 4 set to commence on 21 May.(31)

Many of the factors that have been used to inform decisions in relation to previous frameworks will continue to be taken into account when considering any change in public health measures. Other factors that may be taken into consideration when informing future and existing frameworks include, but are not limited to, the numbers of people who have been vaccinated, emerging information on variants of concern and evidence in relation to vaccine effectiveness.

In Israel, a ‘Green Pass’ system has been introduced as part of the easing of restrictive measures.(17) The ‘Green Pass’ is an entry permit to places or facilities for vaccinated people and those who have recovered from COVID-19. Public health measures are less restrictive in ‘Green Pass’ establishments. You may enter establishments or events that comply with ‘Green Pass’ restrictions, if you present the Pass (either printed or on an App) with an identification document. The ‘Green Pass’ is personal and is valid for six months for those who have been fully vaccinated, effective the week after receiving the second dose for six months and valid until 30 June 2021 for those who have recovered from COVID-19. Additionally, some locations are allowed to operate under a ‘Purple Badge’ system, which permits some activity to occur in the absence of a ‘Green Pass’. Under the ‘Purple Badge’ system these locations (for example, outdoor dining) can open, while adhering to occupancy restrictions, and other infection prevention and control measures. These events and activities operate under a greater level of restriction than those required for the ‘Green Pass’ system.(32)

Further details of the frameworks that have been developed in each country are provided in Appendix B, alongside any criteria or triggers that are being used to inform a change in alert levels or public health measures.

3.3 Current public health measures

Jurisdictions are currently imposing restrictions at various levels. Many are doing so at a nationwide level, (for example, Ireland,(33) the Netherlands,(34) Portugal(35) and Wales(36)), others at a nationwide level with additional regional restrictions (for example Norway,(37) France(38) and Spain(39)), while others are doing so at a regional or municipal level only (for example, Finland,(40) Israel(41) and Italy(10)).

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Table 2 provides a summary of the restrictions in place as at 16 April 2021. In brief, in countries with a published risk framework, all are currently at either the highest risk level of their individual framework or the majority of regions in the country are at the highest risk level, with the exception of Finland,(40) Norway,(37) Italy,(10) England(8) and Israel.(41) Easing of restrictions has commenced in Israel and a ‘Green Pass’ system has been introduced for those who are fully vaccinated and those who have recovered from COVID-19.(41) Establishments that comply with the ‘Green Pass’ restrictions have less restrictive measures than those without and holders of a ‘Green Pass’ can access these establishments. Similarly, ‘Corona Passes’ are being implemented in Denmark to facilitate easing of certain measures such as personal services and hospitality.(42)

Since the previous iteration of this report (date of data extraction 12 March 2021), a gradual easing of restrictions has commenced or continued in 11 of 17 included countries (Norway and Finland were not included in the previous report). These countries comprise Czechia,(43) Denmark,(42) Ireland,(33) Italy,(10) Netherlands,(44) Portugal,(35) England,(8) Northern Ireland,(45) Scotland,(46) Wales(36) and Israel.(41) Two countries eased measures generally except in specific regions with high incidence, where public health restrictions were extended (Austria(47) and Belgium).(48) Three countries extended restrictions nationally (France,(38) Germany(49) and Sweden)(50) in light of deteriorating epidemiological indicators. No change in measures were observed in Spain during this time period.(39) The full details of measures in place in all countries and advised changes to restrictions are provided in Table 3.

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Table 2 Summary of restriction levels and plans for easing as at 16 April 2021.

Country Current Level (16 Changes since previous Comment April 2021) report (12 March 2021) EU countries Austria Very high risk - Red Some restrictions eased. Additional local restrictions (highest) Others extended. Belgium Alarm Level 4 Some restrictions eased. Plans for all secondary level students to return to school full time from April 19. (highest) Others extended. Third level restrictions to be reviewed on April 19. Additional local restrictions Czechia Level 5 Purple Some restrictions eased. N/A (highest) Denmark Risk Level 5 Some restrictions eased. A roadmap for further easing of restrictions has been announced by the Danish (highest) Government, with Phase 2 planned for 21 April. Finland - stable 6 Regions Not included in previous Restaurants to re-open on 19 April with certain restrictions. A roadmap for report. further easing of restrictions has been announced by the Finnish Government, with the National State of Emergency due to be lifted later in April. Finland - acceleration 7 Regions Not included in previous Restaurants will remain closed. A roadmap for further easing of restrictions has report. been announced by the Finnish Government, with the National State of Emergency due to be lifted in April. Finland – community transmission 8 Regions Not included in previous Restaurants will remain closed. A roadmap for further easing of restrictions has report. been announced by the Finnish Government, with the National State of Emergency due to be lifted in April. France Confinement Extension of restrictions. Additional local restrictions. From 26 April, primary schools will start to recommence face-to-face teaching. From 3 May, high schools and universities will start to recommence face-to-face teaching. A gradual re-opening of cultural activities will recommence from mid-May. Germany Not reported Extension of restrictions. The federal and state governments have agreed on five steps to reopen society, based on incidence rates. There are plans by the federal government to impose "emergency break" restrictions, including curfews, on regions with high infection rates. Ireland Level 5/5 (highest) Some restrictions eased. The Government have announced plans for further easing of measures, continuing on 19 April with elite intercounty training permitted. Italy - red 4 red regions Red regions ↑ from 3 to 4 The Government have announced plans for further easing of measures, starting with al fresco dining from 26 April. Italy - orange 17 orange regions Orange regions ↑ from 11 The Government have announced plans for further easing of measures, starting to 17 with al fresco dining from 26 April. Italy - yellow 0 yellow regions Yellow regions ↓ from 6 to The Government have announced plans for further easing of measures, starting 0 with al fresco dining from 26 April. Italy - white 0 white regions White regions ↓ from 1 to 0 The Government have announced plans for further easing of measures, starting with al fresco dining from 26 April.

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Netherlands Severe Level 4 Some restrictions eased. There is a 6 step plan to reopening society starting on 26 April, dependent on the (highest) numbers of people with COVID-19 admitted to hospital. Portugal State of Emergency Some restrictions eased. The State of Emergency was decreed until 30 April. The lifting of lockdown restrictions will take place in 4 phases, which may be reviewed every 15 days according to the epidemiological evolution. Spain National State of No change. N/A Alarm Sweden Not reported Some extension of The Public Health agency of Sweden may introduce stricter guidelines in the restrictions. individual 18 regions. UK countries England Step 2 of Spring Substantial easing of Social restrictions eased. Reopening of outdoor hospitality, personal services and 2021 Roadmap restrictions. non-essential retail. Northern Ireland Stage 2 of reopening Some restrictions eased. Some easing of restrictions on social gatherings, religious services and outdoor sporting activities. Scotland - Level 3 5 Level 3 regions Level 3 regions ↑ from 2 to Some easing of restrictions on social gatherings. 5 Scotland - Level 4 27 Level 4 regions Level 4 regions ↓ from 30 Some easing of restrictions on social gatherings. Some non-essential retail to 27 opening. More schools are open. Wales Alert Level 4 Some restrictions eased. Some easing of restrictions on social gatherings. Some non-essential retail (highest) opening. More schools are open. Non EU/UK countries Norway – national measures Applies nationally, Not included in previous The most stringent measures introduced (local, regional, and national) in an area with certain regional report. that applies. Further easing of restrictions will be guided by the data and not by exceptions dates. Norway – level A 20 Municipalities Not included in previous The most stringent measures introduced (local, regional, and national) in an area report. that applies. Further easing of restrictions will be guided by the data and not by dates. Norway – level B 30 Municipalities Not included in previous The most stringent measures introduced (local, regional, and national) in an area report. that applies. Further easing of restrictions will be guided by the data and not by dates. Norway – level C 0 Municipalities Not included in previous The most stringent measures introduced (local, regional, and national) in an area report. that applies. Further easing of restrictions will be guided by the data and not by dates. Israel Various – Traffic Substantial easing of Green Pass system in operation for those both fully vaccinated and recovered Light Model at restrictions. from COVID-19. council level

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3.3.1 Movement of people

Night time curfews are currently in place in six countries; Austria,(47) Belgium,(48) France,(38) Italy,(10) the Netherlands(34) and Spain.(39) The night time curfew has been lifted in Czechia as of 12 April 2021.(43) The Federal Government in Germany are considering introducing night time curfews (and the closure of schools and businesses) in specific regions, if seven-day incidence rates exceed 100 infections per 100,000 residents over three consecutive days.(51) A number of countries limit movement between regions including Italy,(10) France,(38) Ireland,(33) Scotland(46) and Spain.(39) People are advised to stay at home in the Netherlands(44) and Portugal.(35) In France, travel is currently limited to within 10km of one’s home.(38) In Ireland, travel is currently limited to within one’s county or within 20km of your home if crossing county borders, with certain exceptions.(33)

3.3.2 Social or mass gatherings In Israel, a maximum of 100 people are permitted to meet outdoors (recently increased from 50 people) and a maximum of 20 indoors.(41) For all other countries where gatherings are permitted, the limit for outdoor gatherings is no greater than 20 people (Czechia,(43) Norway(37) and certain regions in Finland)(40) with a limit for indoor gatherings no greater than 10 people, generally from a maximum of two households or that have formed a bubble (Czechia,(43) Denmark,(42) Northern Ireland,(45) and Austria).(47) In Ireland, two households can meet outside but not in a private garden.(33) No indoor socialising is permitted but two individuals from two different households can meet indoors without the need to wear masks or maintain social distance, if they are both fully vaccinated.(33) In Denmark, people who are fully vaccinated can meet anyone else who is fully vaccinated. Fully vaccinated individuals can also meet unvaccinated individuals as long as they are not at high risk of serious disease.(52) While in Sweden, a fully vaccinated older person may meet with relatives who are not symptomatic.(50)

3.3.3 Places of worship/religious services

Places of worship are generally open for private prayer with the exception of Level A regions in Norway.(37) Places of worship are generally open for communal services (albeit with significant capacity restrictions in place), except in a small number of places including Ireland(33) and Level A regions in Norway.(37) Maximum numbers allowed for funerals range from 10 in Ireland(33) to 50 in a number of countries including Austria,(47) Belgium,(48) and the Netherlands.(34) The maximum number of guests permitted at weddings and civil partnerships ranges from five in Level 4 areas in Scotland(46) and in Level A regions in Norway(37) to 50 in Denmark,(42) if held outdoors. In Ireland, a maximum of six guests can attend a wedding ceremony.(33) In Israel, houses of worship without a ‘Green Pass’ are permitted a maximum of 20 people indoors and 100 outdoors. In those houses of worship with a ‘Green Pass’,

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Public health measures and strategies to limit the spread of COVID-19 Health Information and Quality Authority indoor venues with fewer than 5,000 seats can host up to 50% the maximum permitted occupancy and no more than 1,000 people, whereas an outdoor venue with more than 10,000 seats can host up to 30% the maximum permitted occupancy and no more than 10,000 people. If there are more than 5,000 people in the venue, they should be all be seated to prevent crowding.(41)

Business activities

Non-essential retail remains largely closed in Belgium,(48) Czechia,(43) France,(38) Germany,(49) Ireland,(33) Red regions in Italy,(10) the Netherlands,(44) Northern Ireland,(53) Scotland in level 4 regions(46) and Level A regions in Norway.(37) Belgium(48) and the Netherlands(44) permit non-essential retail businesses to operate on an appointment basis. In Austria, where the retail trade has reopened, personal services (e.g. hairdresser, massage, pedicure) may only be used if a negative PCR (valid for 72 hours) or antigen test result (valid for 48 hours) is presented.(47) The test does not apply to people who have been infected with COVID-19 in the past six months and who can prove this with a medical certificate, or if certified evidence can be provided of neutralising antibodies of not older than 3 months. In Denmark, to access personal services such as hairdressers and barbers, there is a requirement for customers to have a ‘Corona Pass’ (i.e. negative PCR test result <72 hours ago, or a positive PCR test between 14 days and 12 weeks old, or proof of completed vaccinations).(42) In Scotland(46) and Portugal,(35) personal services are permissible only through an appointment basis.

Bars and restaurants are open in Spain,(39) Sweden(50) and Israel(41) (and outdoors only in England(8) and Portugal)(35) but are operating with restricted opening hours, reduced capacity and restrictions on the number of people within any one party. In Norway, alcohol may only be served in connection with the serving of food, and may only be served until 10pm, unless in level A regions where bars and restaurants are closed or in level B regions where these premises are open but cannot serve alcohol.(37) Similar to Ireland, those that are closed are largely permitted to provide takeaway service. Where hotels are operating it is generally for exceptional reasons only, including hosting those travelling on business. In Israel, the hospitality sector is operating using the Green Pass system which allows for less restrictive measures.(41) For example, indoor dining in restaurants is only permitted with the Green Pass and enables restaurants to operate at 75% capacity with a maximum of 100 people.

3.3.4 Education

Ireland,(33) Spain,(39) England,(8) Northern Ireland,(45) Scotland(46) and Wales(36) are the only six included countries where all primary and secondary schools are currently fully open for face-to-face teaching, regardless of local or regional restrictions. Primary schools are either partially or fully open for face-to-face teaching in all

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Public health measures and strategies to limit the spread of COVID-19 Health Information and Quality Authority countries except France(38) and Red localities in Israel.(41) Secondary schools are currently operating solely by distance learning in France(38) and Portugal.(35) Most other countries are operating a combination of face-to-face and distance learning for secondary school students either rotating classes between the two or implementing a gradual return to face-to-face teaching by year group. Universities are generally operating by distance learning with exceptions for practical and laboratory based classes, as is the case in Ireland.(33)

In Austria, a weekly negative rapid test, which is carried out at the school, is required to participate in face-to-face lessons.(54) For pupils at elementary schools, special schools and pupils who are at school for more than two days, tests should be carried out up to three times a week. If a doctor's confirmation of a COVID-19 infection or proof of neutralizing antibodies can be presented that is no longer than six months ago, no test needs to be carried out.

3.3.5 Domestic travel (including transport)

Public transport capacity has been reduced in Ireland,(33) Israel,(41) Portugal,(35) Wales,(36) and Finland during the Acceleration or Dissemination/Community Transmission phases,(40) although school transport is not affected. In Sweden, capacity is restricted to a maximum of 50% on bus and train services where the line distance is greater than 150 km.(50) There is a general recommendation in a number of countries to avoid public transport at rush hour and at times when it is likely to be busy.(50) In Austria, only two people are permitted per row in taxis and when car- pooling.(54)

3.3.6 Culture/leisure/entertainment

Outdoor facilities including parks, playgrounds, gardens, lakes and beaches are generally open, with the exception of Czechia.(43) Zoos are also open in a limited number of countries. Indoor public buildings are largely closed with the exception of libraries in most countries and museums in Austria,(54) Belgium,(48) Israel,(41) Portugal(35) and Spain.(39) Outdoor cultural institutions have reopened in Denmark but visitors are required to present documentation for negative testing that is no more than 72 hours old.(42) In Germany, zoos, zoological gardens, animal parks, museums and galleries can open if there is a 7-day incidence of less than 50 new infections per 100,000 in a region.(49) Where incidence is >50/100,000 inhabitants, these facilities can open provided an appointment is made and visitors are documented.(49)

Indoor entertainment facilities (for example theatre, bowling alleys, and cinema) are generally closed, with some exceptions. In Spain, some regions may permit indoor entertainment, but all attendees must register.(39) In Israel, people with a ‘Green

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Pass’ may avail of certain indoor activities such as ice skating and bowling.(41) Sweden permits a maximum of eight people in total to attend public gatherings and events, and this includes the theatre and cinema.(50) In regions of Norway without additional restrictions, there is a maximum number of 100 people permitted at indoor cultural events assuming there is sufficient social distancing and all participants have designated seating.(37)

3.3.7 Sporting/recreational activities (amateur and professional)

Indoor sports centres, fitness centres and swimming pools remain largely closed with some exceptions. In Israel, gyms and swimming pools are open for ‘Green Pass’ holders.(41) Swimming pools and gyms have reopened for individual exercise in England.(8) Swimming pools are also open in Portugal(35) and in Finland (except in Dissemination/Community Transmission regions).(40) Outdoor facilities are generally open but are operating with varying restrictions around individual and group activities and the numbers permitted.

In Belgium, indoor facilities (except swimming pools) are open for children up to 12 years old participating in compulsory school or extracurricular activities(48) and children up to aged 12 can attend swimming lessons in the Netherlands.(34) Similarly in Sweden, young people born in 2002 or later may participate in organised sports and leisure activities, both indoors and outdoors.(50) Organised outdoor contact sport, non-contact sport, exercise, personal training, coaching and group activities are permitted for those aged under 12 in Scotland.(46) A maximum of 50 young people are permitted to gather for sports activities in Denmark.(42) In Belgium, a maximum of 10 children under 13 years can partake in organised sports activities that occur ideally outdoors.(48) A maximum of 15 young people aged 12-17 years can travel and participate in outdoor non-contact sport and organised group exercise in Scotland.(46) Relaxed measures for the purpose of physical exercise among children and young people are also in place in Austria,(47) France,(38) the Netherlands,(44) England,(8) Israel(41) and Norway.(37)

In the Netherlands, adults aged 18 to 26 years can participate in team sports outdoors at sports facilities without staying 1.5 metres apart.(34) However, for adults aged 27 years and over the numbers are restricted to a maximum of four people and they must stay 1.5 metres apart.(34) In Scotland, a maximum of 15 adults can meet for outdoor non-contact sport and organised group exercise.(46) In Germany, a maximum of 10 people can meet outdoors for non-contact sport in regions with a seven-day incidence below 50 per 100,000 population.(49) Similarly in Belgium, a maximum of 10 amateur athletes can exercise together in groups outdoors.(48) In most other countries, including Ireland,(33) outdoor non-contact sport for adults is permitted with no more than one other person from outside your household. (46)

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Professional and elite sport training and competition is largely unaffected, but in most countries it must take place behind closed doors.

3.4 Testing strategies

A review of each country’s approach to testing was undertaken as part of this report. The information, described separately below for each strategy, was extracted on 16 April 2021.

3.4.1 International testing strategies

As a strategy, all countries included in this review target their testing on symptomatic individuals, with the exception of Austria, Czechia, Denmark, England, France, Germany, Israel and Portugal, where anyone can request a COVID-19 test irrespective of the presence of symptoms; priority is given to symptomatic individuals in these countries.(47, 55-61)

High-risk groups based on pre-existing conditions, age or setting are specifically prioritised in the national strategies for Belgium, Czechia, England, Finland, France, Germany, Ireland, Israel, the Netherlands, Norway, Scotland and Sweden.(61-73) However, most countries have expanded testing to include screening of asymptomatic individuals in certain situations.

Internationally, asymptomatic testing is mostly aimed at frontline staff and residents of care facilities (RCF) or healthcare users. For example, regular testing is conducted on staff and residents in long-term care facilities (LTCF) including residential care facilities for older people in Austria, Belgium (if the vaccination rate for residents <90% or staff members <70%), Czechia, Denmark, England, Finland, Italy, Ireland, Northern Ireland, Norway, Portugal, Scotland, Spain, Sweden and Wales.(47, 56, 63, 64, 69, 74-81) Czechia, Denmark, England, Germany, the Netherlands, Northern Ireland, Norway, Portugal, Scotland, Spain and Wales conduct regular testing across a wide range of health and social care workers including non-clinical staff.(56, 63, 64, 68, 69, 76-78, 82-84) While serial screening is activated for all health and social care settings when regional incidence levels reach a certain level in Belgium or in the event of the first confirmed case in Finland (only when testing capacity is available) and France. Testing is offered to visitors of RCFs in Austria, Belgium, Denmark (with a confirmed case), England, the Netherlands, Scotland and Wales and for visitors for all healthcare services in Czechia and Germany.(47, 56, 63, 64, 66, 85-88)

Other non-healthcare settings have implemented asymptomatic screening strategies, these include screening workers in key industries (Austria, Belgium, Czechia, Denmark, England, France, Germany, Ireland, Italy, the Netherlands, Northern Ireland, Norway and Portugal) and schools and or universities (Austria, Denmark,

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England, Italy, the Netherlands, Northern Ireland, Portugal, Scotland and Wales).(56, 64, 85, 86, 89-95) Additionally, Czechia is conducting mandatory screening in companies (with more than 10 employees) and for people who are self-employed who meet with the public.(96) Denmark requires proof of a negative PCR test result within the last 72 hours (or a positive PCR test between 14 days and 12 weeks old, or proof of completed vaccinations) for entry to a wide range of hospitality, cultural, sports and shops and services.(97) Denmark, the Netherlands and Israel permit screening at public events, such as sport performances and concerts.(96, 98-100)

Use of rapid antigen tests has been supported in all included countries. The requirement for a confirmatory RT-PCR test (following either a positive or a negative rapid antigen test) depends on the country and the circumstances in which the test is being used. For example, in Ireland, rapid antigen tests can be used in suspected outbreaks involving vulnerable populations. The rapid antigen test can only be used in people with symptom onset of less than five days. If the rapid antigen test is positive in this situation, a confirmatory PCR test is not needed, though at least one person in the outbreak should be tested using PCR. If the rapid antigen test result is “not detected”, and the pre-test probability of infection is high in this instance (i.e. symptomatic person and high community prevalence), a PCR test is recommended to confirm this test result.(101) In contrast, confirmatory RT-PCR testing is required following a positive rapid antigen test when the pre-test probability of infection is low (serial testing in meat processing plant). England has reintroduced confirmatory PCR testing for positive lateral flow test results, given concerns regarding false positives at times of low prevalence in the community.(102, 103) Other types of rapid tests currently in use include self-tests which are used in Austria, Czechia, England, Germany, Portugal, Scotland, Sweden, and Wales with a pilot underway in the Netherlands,(60, 64, 79, 87-89, 105-108) as well as saliva tests (pilot testing) and breath tests.(64, 86, 88, 109)

Austria and Czechia have implemented population-wide testing.(89, 110) While Germany, Ireland, Norway, Portugal, Sweden (some regions) and the UK (all four jurisdictions) have a strategy to implement regional or community wide asymptomatic testing available through walk-in testing centres and at various community settings including workplaces and schools in the event of an increased incidence or in high risk communities.(81, 111-113) The Netherlands has begun large scale testing pilots with the aim of expanding the programme to population-wide screening.(114) Previously, a municipality (South Tyrol) in Italy had expanded their screening programme to include voluntary antigen testing of randomly selected citizens from selected subgroups, once a week for four weeks.(115)

Guidance from three countries was identified that included considerations for testing based on vaccination status. These were: Belgium (if less than 90% of residents of

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Public health measures and strategies to limit the spread of COVID-19 Health Information and Quality Authority the RCF are vaccinated, then testing of visitors is recommended), Czechia (exempt from all testing in all settings if fully vaccinated) and Denmark (staff who are 14 days after final dose can refrain from testing if more than 80% of residents are fully vaccinated).(56, 85, 110) Guidance from Sweden and England state that testing according to the sampling indication applies regardless of vaccination status.(79, 116)

Further details of each country’s approach to testing are provided in Appendix C.

4 Conclusion

Public health measures are currently being applied across all countries included in this review, either nationally, regionally or a combination of both. Most countries continue to operate at the highest level of their respective risk framework, if applicable. Although the measures that are being applied are largely consistent, there are many differences in the detail between countries. The more prominent differences between countries include how movement is restricted (for example, curfew hours and travelling distances permitted); numbers permitted at gatherings, events, religious services and sporting activities; and the operating hours of businesses allowed to open within the hospitality sector. The situation remains extremely fluid with gradual easing of current restrictions well underway in some countries, particularly in those with high levels of vaccination coverage. However, further restrictions have been re-introduced regionally or nationally in some countries as a result of deteriorating epidemiological indicators.

Most countries broadly saw a reversal of the effects of the most recent increase in coronavirus cases from December (2020)/January (2021). However, the latest epidemiological data shows an increase in the 14-day incidence rate per 100,000 population over the previous seven days in Germany, the Netherlands, Portugal, Spain, and Sweden. A small number of countries, including Austria, Germany, Norway, and Sweden, have seen an increase in the 14-day death rate per million population over the previous seven days, while the rate of hospitalisations and admissions to intensive care increased in several countries. Each of the included countries have begun vaccinating people against COVID-19. To date, Israel and the UK have had the highest reported number of vaccine doses administered per 100 population of the included countries. Reassuringly, the epidemiological situation in these countries continues to improve; for example, the 14-day incidence rate of new cases per 100,000 population declined on 18 April 2021 by 30.2% and 22.2% over the previous seven days in Israel and the UK, respectively.

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While a range of epidemiological data are presented here to describe the current situation in each country, it is important to note that comparisons across countries are difficult for a number of reasons.

1. The number of cases in any country can be heavily influenced by (1) the testing strategy adopted in that country and (2) case definition used, which can vary over time, causing large and small fluctuations in the number of new cases recorded each day. The number of new cases on a given day can also be affected by the return of awaited or delayed test results, as well as reduced testing on the weekends or outsourcing of testing.

2. The number of deaths in any country is affected by (1) the way in which deaths are recorded and (2) the age profile of the population. Some countries do not record deaths across all sectors (for example, hospitals, long-term care facilities), while others report confirmed deaths only.

3. Comparisons of the rate of testing across countries is complicated by the varying units used to describe ‘tests performed’. In some countries this may refer to the number of people tested, whereas in other countries, it may refer to the number of tests performed. It is also important to note that some variations in the epidemiological data (such as the 14-day notification of new cases) may be observed across different data sources due to differences in underlying population data. The population data used for this analysis vary by data source. In the case of Ireland, the ECDC base their estimate on 2019 Eurostat data,(117) while OWID use World Population Prospects data, published by the United Nations.(118) In the case of Ireland, the ECDC base their estimate on 2019 Eurostat data,(117) while OWID use World Population Prospects data, published by the United Nations.(118)

As a national strategy, individuals displaying symptoms consistent with COVID-19 are prioritised for testing in each of the countries included in this review. In Austria,(119) Czechia,(110) Denmark,(56) England,(120) France,(58) Germany,(66) Portugal,(60) and Israel,(61) however, testing is provided for anyone that requests a test, irrespective of the presence of symptoms. High-risk groups based on pre- existing conditions, age or setting are specifically prioritised in the national strategies of 12 of the 19 countries. All countries have expanded testing to include screening of asymptomatic individuals in certain situations. This is mostly aimed at frontline staff and residents of care facilities or healthcare users. For example, serial testing is conducted on staff and or residents in long-term care facilities, while some provide tests to visitors to long-term care facilities. Screening programmes are also being implemented in non-healthcare settings, such as in education settings and critical industries. Two countries have implemented population wide testing, while nine countries have a strategy to implement regional or community wide testing in a

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Public health measures and strategies to limit the spread of COVID-19 Health Information and Quality Authority range of settings, including workplaces and schools in the event of an increased incidence or in high risk communities. Testing based on either unsupervised self-test (sample and test processing by patient) or self-sampling (sample collected by patient, but test processed by trained staff) is in widespread use in eight of the 19 countries included, with a pilot study underway in the Netherlands.

Although a comprehensive search of international resources was undertaken, it is possible that the sources identified in this review are not current or do not accurately capture all public health measures and strategies that are being undertaken. For example, some countries may have expanded testing beyond what was observed in this review, or could be using rapid or near-patient tests to support the diagnosis of current infection with SARS-CoV-2 in settings not identified in this review. In addition, the public health measures adopted by countries to limit the spread of COVID-19 are constantly changing. As such, the review may have missed relevant information that was just (or about to be) published at the time of the review. To the best of our knowledge, the review is accurate as of 16 April 2021.

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Table 3 Summary of current public health measures by country (extracted on 16 April 2021)

Austria(47) Current Level: Very high risk – Red Effective from and to: 01/04/2021 – Various Movement of people ▪ Curfew from 8pm to 6am with exceptions. ▪ Home working where possible. Social/mass gatherings Households ▪ Max 2 households may meet in one house between 6am and 8pm with max 4 adults and max 6 children who must be supervised. This also applies to private areas outside the living area (e.g. gardens, barns, sheds, garages).

Events ▪ Events prohibited (e.g. birthday parties, wedding celebrations, cultural events, sporting events). Exceptions to this are: - Rehearsals and artistic performances without an audience that take place for professional purposes. - Professional meetings that cannot be postponed and meetings for absolutely necessary professional training and further education purposes are possible. - Demonstrations.

Places of worship ▪ Religious services are allowed with 2m distance and FF2 masks, and no singing.

Funerals ▪ Max 50 people. Business Activities Retail ▪ Shops open from 6am until 7pm at the latest, with the exception of pharmacies and petrol stations. ▪ An area of 20m² must be available for each customer. ▪ In shopping centres there is a ban on staying in the general areas. The consumption of food and drinks is not permitted there.

Services ▪ All services may be offered. ▪ However, personal services (e.g. hairdresser, massage, and pedicure) may only be used if a negative PCR (valid for 72h) or antigen test result (valid for 48 h) is presented. The test does not apply to people who have been infected with COVID-19 in the past 6 months and who can prove this with a medical certificate. Also excluded are people who can provide evidence of neutralizing antibodies (not older than 3 months). ▪ An area of 10m² must be available for each customer.

Food and beverage ▪ Catering establishments may offer pick-up from 6am to 7pm. Delivery service is available 24/7. ▪ Consumption on site is not permitted (exception: company canteens).

Accommodation ▪ May only be used in exceptional cases, in particular for professional purposes.

Employees of the following occupational groups are now obliged to undergo a PCR or antigen test at least every 7 days: - Teachers with direct contact with students, - Employees in childcare facilities with direct contact with the children, - Employees in the field of warehouse logistics, if the distance rule cannot be consistently adhered to, - Employees with direct customer contact and - Persons who are involved in party relations in administrative authorities and administrative courts

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Public health measures and strategies to limit the spread of COVID-19 Health Information and Quality Authority

Table 3 Summary of current public health measures by country (extracted on 16 April 2021)

Austria(47) Current Level: Very high risk – Red Effective from and to: 01/04/2021 – Various Primary schools ▪ Returning to face-to-face teaching.

The following applies to face-to-face teaching: ▪ A weekly negative corona rapid test, which is carried out at the school, is required to participate in lessons. For pupils at elementary schools, special schools and pupils who are at school for more than 2 days, tests should be carried so that there is no more than 1 calendar day between the tests (i.e. up to 3 tests per week). If a doctor's confirmation of a corona infection no longer than 6 months ago or proof of neutralizing antibodies can be presented for a period of 6 months, no test needs to be carried out. Higher and adult education ▪ Universities will remain in distance learning until further notice. Domestic travel ▪ In mass transportation and associated underground stations, platforms, stops, train stations and airports, people who do not live in the same household (including transport) must be kept a distance of at least 2m. If it is not possible to maintain a distance of at least 2m due to the number of passengers and when boarding and alighting, this can be accepted. ▪ In motor vehicles (private car, taxi, Uber) max 2 people per row of seats may be transported (exception: shared household). ▪ Cable cars, gondolas & ascent aids: With closed and covered vehicles, max 50% of the transport capacity may be used. Operators have to implement appropriate prevention measures based on a risk analysis. Culture/leisure/ Open entertainment ▪ Museums, art halls, cultural exhibition halls, libraries and archives. - The 20m² rule per visitor applies. ▪ Animal parks, zoos and botanical gardens. - The 20m² rule per visitor applies.

Closed ▪ Theatres, cinemas, amusement parks.

Extracurricular youth education and youth work ▪ Permitted under the following conditions: - Group size is a maximum of 10 people up to the age of 18 and a maximum of 2 carers - May be indoors or outdoors, but the young people are required to be tested for indoors - There is a registration requirement - The organizer has to develop and adhere to a mandatory prevention concept.

Meetings of self-help groups ▪ Can take place indoors and outdoors.

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Public health measures and strategies to limit the spread of COVID-19 Health Information and Quality Authority

Table 3 Summary of current public health measures by country (extracted on 16 April 2021)

Austria(47) Current Level: Very high risk – Red Effective from and to: 01/04/2021 – Various Amateur sport and Sports recreation ▪ Individual and recreational outdoor sports are allowed if there is no physical contact in the sport-specific exercise. ▪ Contact sports not permitted. ▪ For children up to 18 years, non-physical contact sport outdoors is permitted (no test requirement). There is a max of 10 players and a max of 2 trainers. Registration is required.

Sports facilities ▪ Outdoor sports facilities are open (e.g. ice rink, cross-country trails). The distance rule of at least 2m and the 20m2 rule per person apply. ▪ Indoor sports facilities remain closed. ▪ Cable cars are open with max 50% occupancy in gondolas and on armchairs that can be covered. Professional sport ▪ Permitted. Other Leaving the following regions is currently only permitted with a negative PCR (not older than 72 hours) or antigen test (not older than 48 hours): - Burgenland - Carinthia - Lower Austria: Neunkirchen, Wiener Neustadt Stadt, Wiener Neustadt Land, Scheibbs district - Upper Austria - Salzburg - Styria - Tyrol: North Tyrol, Kufstein district, Fulpmes im Stubaital, Lienz district: Prägraten am Großvenediger, Virgen, Sillian, Heinfels, Ausservillgraten, Innervillgraten, Anras, Abfaltersbach, Assling and Leisach, Reutte district: Weißenbach am Lech (except Gaicht) - Vorarlberg - Vienna.

▪ For the federal states of Burgenland, Lower Austria and Vienna, the following additional, stricter measures apply from April 1 to April 18 inclusive:

▪ Stay at home, with certain exemptions. ▪ In meetings that applies 1 + 1 rule, both indoors and outdoors: 1 household (or family members / relatives close caregiver) may meet with a max of 1 individual. ▪ Shops are closed except groceries and pharmacies ▪ Click & Collect is possible for all stores. The goods must be handed over outdoors. ▪ Personal services may not be offered. ▪ School operation: All schools remain in distance learning until April 16. ▪ All cultural and leisure facilities are closed. ▪ Meetings in the field of youth sports and youth work are prohibited.

▪ There is a controlled opening of Vorarlberg State.

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Public health measures and strategies to limit the spread of COVID-19 Health Information and Quality Authority

Table 3 Summary of current public health measures by country (extracted on 16 April 2021)

Belgium(48) Current Level: Alarm Level 4 Effective from and to: 24/03/2021 – Various Movement of people ▪ You are allowed to move around freely. ▪ Curfew from midnight to 5am (Brussels curfew is 10pm-6am). ▪ Working from home mandatory where possible. Social/mass gatherings Social gatherings ▪ Gatherings outdoors are limited to a maximum of four people (not including children up to the age of 12). ▪ Each member of a household can meet one close contact on a regular basis every 6 weeks at home or in a tourist accommodation. ▪ In addition, if you live alone, max 1 close contact and 1 other person can be invited into your home. These people cannot be in your house at the same time.

Funerals, worship and weddings ▪ Funeral: Max 50 people excluding children up to the age of 12 and the minister of religion provided that there is a space of 10 sqm per person. ▪ Wedding: A maximum of 15 people, excluding children up to the age of 12, the civil registrar and the minister of religion, may attend. ▪ Places of worship may remain open for individual visitors but only a max of 15 people may be present in the building at any one time excluding children under the age of 12 and the minister of religion

Demonstrations ▪ On public roads are allowed with a maximum of 100 participants ▪ Must be static and abide to social distancing measures Business Activities Retail ▪ Only essential shops remain open ▪ Non-essential shops can still offer home deliveries and operate a click-and-collect (collected outside) or appointment-only system.

For shops that are open (essential or through appointment), they must adhere to the following conditions: - Consumers are admitted for a maximum of 30 minutes. - For shops, the rule of one customer per 10m² applies. - Shops with a surface area of less than 20m² can allow max 2 customers at the same time, provided that social distancing rules are respected. - Large stores of more than 400m² must provide for access control. ▪ Shop alone.

For appointment-only services, they must additionally comply with the following: ▪ customers can only enter during reserved time slot ▪ no more than 50 customers are allowed simultaneously inside the shop ▪ only activities that are connected with the immediate sales process may take place inside the shop

Offering goods at and in a home is prohibited (e.g. demonstrations of household products). However, goods ordered in advance can be delivered to and installed in a home. Only 1 visitor per home is allowed per 10m² and they must travel alone

▪ Night shops open until 10pm. ▪ Alcohol sales prohibited between 8pm and 5am.

Markets

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Public health measures and strategies to limit the spread of COVID-19 Health Information and Quality Authority

Table 3 Summary of current public health measures by country (extracted on 16 April 2021)

Belgium(48) Current Level: Alarm Level 4 Effective from and to: 24/03/2021 – Various ▪ Food markets can keep operating. ▪ Consuming food or beverages on site is not allowed. ▪ Flea markets prohibited.

Food and beverage ▪ Bars, cafés and restaurants closed. ▪ Takeaway until 10pm. ▪ Alcohol sales prohibited between 8pm and 5am ▪ Delivering or selling alcoholic beverages to take away is only permitted in combination with a meal, and only until 8 pm

Contact professions ▪ Hairdressers/barbers closed (and may not offer services by appointment) ▪ Nail salons closed (and may not offer services by appointment) ▪ Beauticians closed (and may not offer services by appointment) ▪ Tanning salons can reopen by appointment basis only if manned. If unmanned they must remain closed. ▪ Non-medical pedicure salons closed (and may not offer services by appointment) ▪ Massage parlours closed (and may not offer services by appointment) ▪ Tattoo parlours/piercing salons closed (and may not offer services by appointment) ▪ Close-contact professions that are not allowed to offer their services may offer their goods (e.g. hair care and other personal care products) through a click-and-collect system, via home deliveries or by means of an appointment-only system

Other services ▪ Driver lessons, driving tests and aviation training can continue operating ▪ Photography services can continue operating ▪ Real estate viewing can continue operating ▪ Renovation and construction works can continue in private home

Accommodation ▪ Hotels and B&Bs can remain open, but the restaurants and bars have to close. ▪ Meals must be served in room.

At work ▪ The employer provides staff members who are unable to work from home with a certificate or any other evidence confirming the need for their presence at the workplace. ▪ Face-to-face team building sessions are prohibited. ▪ Every month, employers must register the total number of employees in the company per operating unit as well as the number of employees who are unable to work from home due to their role. ▪ Company canteens are allowed to remain open. Primary schools ▪ Open for face-to-face teaching. Secondary schools ▪ Pupils of the first stage of secondary education can follow 100% contact education. ▪ Pupils in the second and third stage of secondary education will continue to follow at least 50% distance education for the time being. ▪ The intention remains, as soon as possible, to make 100% contact education possible for all pupils, dependant on national metrics which will be reviewed

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Public health measures and strategies to limit the spread of COVID-19 Health Information and Quality Authority

Table 3 Summary of current public health measures by country (extracted on 16 April 2021)

Belgium(48) Current Level: Alarm Level 4 Effective from and to: 24/03/2021 – Various every 2 weeks. ▪ Day trips are allowed (indoors and outdoors). ▪ Multi-day domestic excursions are not allowed until May 16; foreigners are not allowed until at least 31 May. Higher and adult education ▪ Distance learning until at least 18 April Domestic travel ▪ Permitted to move around freely. (including transport) ▪ From 3 to 18 April 2021 and on 24 and 25 April 2021, capacity on trains with a tourist destination must be limited so that preventive measures are respected. As a result, only window seats may be occupied, with the exception of children up to the age of 12, who may sit next to accompanying adults. Culture/leisure/ Open entertainment ▪ Outdoor playgrounds. ▪ Museums. ▪ Outdoor areas of nature parks, zoos and animal parks, including entrances, exits, sanitary facilities and first aid and emergency buildings. ▪ Swimming pools, excluding the recreational areas and subtropical swimming pools. ▪ Libraries, game and multimedia libraries. ▪ Places of worship and buildings intended for the public practice of non-denominational moral services. ▪ Cultural places, however, only for groups of children up to the age of 12, as part of compulsory school or extracurricular activities. ▪ Courses and activities for children up to the age of 18. ▪ Private saunas for use by people within a household or close and permanent contact.

Closed ▪ Casinos, fruit machine halls and bookmakers. ▪ Wellness centres, including saunas, unmanned sunbed centres and unmanned tanning salons, Jacuzzis, steam rooms and hammams. ▪ Night clubs and dance halls. ▪ Party and reception venues. ▪ Amusement parks. ▪ Indoor playgrounds. ▪ Bowling alleys. ▪ Fun fairs, year markets, flea markets, bric-a-brac markets, Christmas markets and winter villages. ▪ Trade fairs including exhibitions. ▪ Cinemas. ▪ Fitness centres. ▪ Ski slopes, cross-country ski trails and ski centres. Amateur sport and ▪ Max 10 amateur athletes can exercise together in groups outdoors (including the coach). recreation Facilities ▪ Outdoor areas of sports facilities are open. ▪ Indoor facilities (or parts of them) belonging to the sports sector are closed to the public. However, indoor sports halls and facilities remain open for: - Groups of children up to the age of 12 years, as part of compulsory school or extracurricular activities, with the exception of swimming pools. - Sports activities, courses and camps organised or authorised by the local authorities for children up to the age of 18 years. ▪ Indoor horse arenas in equestrian centres and racecourses also remain open, however, this is for the sole purpose of animal welfare.

Sports activities ▪ For children under 13 years, organised outdoor activities (sports and others) permitted with max 10 people, ideally outdoors (supervisor not included)

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Table 3 Summary of current public health measures by country (extracted on 16 April 2021)

Belgium(48) Current Level: Alarm Level 4 Effective from and to: 24/03/2021 – Various ▪ For young people aged 13 to 18 inclusive, organised activities can only take place with a max 10 people outside (supervisor not included). For this age group, these activities are not allowed indoors, except in a swimming pool. Training for this age group can only take place outside or in a swimming pool, with a max of 4 people and social distancing measures. ▪ All sports competitions for non-professionals, regardless of the age group of the participants, are not allowed. ▪ Activities may only take place without an audience, except for non-professional sports training where each participant may be accompanied by a max of 1 member of the same household. ▪Training and activities for amateur athletes 19 years and older can only take place outside or in swimming pool, with a max of 4 people and social distancing measures. Professional sport ▪ Professional athletes can continue to train, both indoors and outdoors, but these sessions should take place without an audience. ▪ Professional events can go ahead but no spectators are allowed to attend. Other ▪ Some cities and municipalities will also have extra rules in place.

▪ If possible, all pupils in secondary schools will return to school full-time after the Easter break on Monday 19 Apr. Measures will also be reviewed for third level institutions on 19 Apr. ▪ Plan to reopen terraces for food and drink from May 8, but not indoors.

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Public health measures and strategies to limit the spread of COVID-19 Health Information and Quality Authority

Table 3 Summary of current public health measures by country (extracted on 16 April 2021) Effective from and to: 12/04/2021 – Various Czechia(43) Current Level: Level 5 Purple

Movement of people ▪ Since 12 April, the inter-district movement restrictions has been lifted, and the night time curfew has been lifted. ▪ Outdoor movement should still be kept to a minimum. ▪ Work from home, where possible. ▪ Nature trips, involving 2 individuals, or a household are permitted. ▪ Camping is not permitted. Social/mass gatherings Social gatherings ▪ Personal contacts should still be kept to a minimum. ▪ From 12 April, the number of persons allowed to be present at certain organised events are limited to 10 for indoor events and 20 for outdoor ones. However, celebrations of birthdays and anniversaries are restricted to household members only.

Demonstrations ▪ Max 100 participants with small clusters of max 20 people with at least 2 meters between the clusters. ▪ All participants of the demonstration must wear a face mask or other respiratory protection. ▪ No indoor demonstrations allowed.

Religious gatherings ▪ Individual visits to churches, synagogues and mosques are permitted. ▪ From April 12, organized pilgrimages will again be allowed to take place, provided the amount of participants will not exceed 20 and all participants will adhere to all hygienic regulations ▪ From April 12, shaking hands during the sign of peace will be allowed ▪ 10% of total seating capacity permitted at religious services/gatherings. ▪ You are allowed to attend a service or similar religious gathering held in your district of permanent residence only. ▪ Singing together during a service is not allowed. Singers or choir members must stay in a structurally separated space

Funerals and weddings ▪ Max 15 people at funerals. ▪ Max 15 (if indoors) or 20 (if outdoors) people at wedding ceremonies. ▪ The wedding reception cannot be held in restaurants or similar facilities. Business Activities Retail ▪ Generally closed with the following exceptions: - Grocery stores - Fuel and other equipment stores for the operation of motor vehicles - Shops of hygienic goods, cosmetics and other drugstore goods - Pharmacies, dispensaries and medical devices - Animal feed and other pet stores - Stores for glasses, contact lenses and related goods - Newspaper and magazine stores - Tobacco shops - Establishments enabling the collection of goods and consignments purchased remotely - Gardening supplies, including seeds and seedlings - Flower shops - Household goods stores and hardware stores, with furniture, carpets and other floor coverings not being considered as household goods.

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Table 3 Summary of current public health measures by country (extracted on 16 April 2021) Effective from and to: 12/04/2021 – Various Czechia(43) Current Level: Level 5 Purple

- Pet stores, opticians, laundries and dry cleaners, shops for spare parts for transport vehicles, including manufacturing technologies, shops with reverent goods, stationeries - children's clothes and shoes.

▪ If a store offers both permitted and unauthorized goods, it must separate the goods. ▪ Exempt shops can be open from6am until 8.59pm. ▪ Stores must close on public and non-public holidays. ▪ Gas stations, pharmacies and shops at airports, railway stations and medical facilities are exempt from the mandatory opening hours.

Food and beverage ▪ From 12 April, restaurants in accommodation facilities can open for their guests from 6 am to 10 pm (during this time the dispensing window can stay open for the public). Accommodation can be provided for people without a home only if this is mediated by the local government bodies ▪Restaurants, pubs, bars and clubs are now closed including the restaurant gardens. However, it is possible to have a takeout window from 6am to 9.59pm. Food deliveries can work all day. Only soft drinks (hot/cold) and food can be sell out of the dispensing window. ▪ Drinking alcohol is prohibited in the area of restaurant establishments, their surroundings and in all public places (e.g. parks, stops, housing estates, squares, shops, etc.).

Markets, marketplaces and mobile facilities ▪ The following may be sold: fruit and vegetables (fresh or processed), flowers and other plants, seeds, milk and milk products, meat and meat products - including raw fish, eggs, bakery and confectionery, honey and other products.

Accommodation ▪ Closed with a number of exceptions.

Other services ▪ In-person real estate viewings can now resume. ▪ Road vehicle servicing and repair facilities, locksmiths and the servicing of other household products will be able to open for public. ▪ Hairdressing and manicure services must remain closed. Primary schools ▪ From 12 April, primary school students will start to return to school. Online teaching remains in place except for: - primary schools intended for children of medical workers - primary schools intended for institutional or protective care - participation in individual consultations (one student and one consultant) - children in the preparatory class - 1st grade pupils in a school in which the number of 1st grade pupils is at most 75 pupils, if the building of this 1st grade is structurally separated from the building of the 2nd grade of primary school, including the school canteen. Otherwise 1st grade pupils are split in half and attend in-person every second week - Maximum groups of 6 pupils of 2nd or 9th grade pupils at risk of school failure. ▪ Outdoor schools and school trips are prohibited ▪ Personal presence in after-school clubs is allowed for the students attending presence education. It is vital to maintain non-mixing of groups. There is a valid exception for children of employees of selected professions (e.g. healthcare), these after-school clubs operate in a special regime ▪ Operation of art/music and language school is prohibited, with some exceptions:

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Public health measures and strategies to limit the spread of COVID-19 Health Information and Quality Authority

Table 3 Summary of current public health measures by country (extracted on 16 April 2021) Effective from and to: 12/04/2021 – Various Czechia(43) Current Level: Level 5 Purple

- State language exam (max 10 people in room) - Participation in individual consultations/teaching (one student and one consultant/teacher)

▪ As of 30 March 2021, employees working at school facilities including teachers, who take care of children from 2 to 10 years of age, must undergo testing (PCR or antigen) in order to be permitted entry into the facility. The test must be negative and must not be more than 7 days old. The obligation applies to employees who are personally present at the workplace. Secondary schools ▪ Online teaching except for: - schools founded for institutional or protective care - schools founded by the Ministry of Justice - participation in clinical and practical teaching or practice of medical field students (general medicine, dentistry, pharmacy and other) and pedagogy field students carrying out practical teaching or practice within their study plan - participation in individual consultations (one student and one consultant) - participation in entrance exams, final exams and internationally recognized exams - participation in exams organized by higher vocational schools for max 10 individuals - participation in resit exams organized by secondary/grammar schools and conservatories. - practical training in driving motor vehicles for pupils and students in which the acquisition of a driving license by designated groups is part of the education

▪ Starting from the 12 April 2021, pupils having troubles with understanding the curriculum are allowed to arrange presence consultations limited to 6 individuals in one group. Individual consultations (1 teacher, 1 student + legal guardian) are also allowed.

▪ Outdoor schools and school trips are prohibited ▪ Personal presence in after-school clubs is allowed for the students attending presence education. It is vital to maintain non-mixing of groups. ▪ There is a valid exception for children of employees of selected professions (e.g. healthcare), these after-school clubs operate in a special regime. ▪ Accommodation of students with another residency within the Czech Republic is prohibited. ▪ Operation of art/music and language school is prohibited, with some exceptions: - state language exams (max 10 people in room) - participation in individual consultations/teaching (one student and one consultant/teacher). Higher and adult education ▪ Online teaching. ▪ Attendance at exams with more than 10 people at a time is not permitted. An exception from this rule applies to examinations in medical professions. ▪ Accommodation of the university students with other residency within the Czech Republic than university dormitories is prohibited. Domestic travel ▪ There is no longer a restriction on regional travel. (including transport) ▪ Trips to a secondary residence are permitted but only with household members. Culture/leisure/ Open entertainment ▪ Libraries for collection only.

Closed/banned ▪ Theatres and cinemas. ▪ Zoos and botanical gardens. ▪ Museums, galleries and exhibition spaces. ▪ Castles and similar historical and cultural sites. ▪ Gaming, casino and betting offices. ▪ Concerts and festivals

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Public health measures and strategies to limit the spread of COVID-19 Health Information and Quality Authority

Table 3 Summary of current public health measures by country (extracted on 16 April 2021) Effective from and to: 12/04/2021 – Various Czechia(43) Current Level: Level 5 Purple

▪ Dance classes ▪ Group singing Amateur sport and Open/Permitted recreation ▪ Skating in natural areas. ▪ Cross-country skiing.

Closed ▪ Leisure centres. ▪ Sports facilities. ▪ Swimming pools. ▪ Wellness facilities, including saunas, solariums and salt caves. ▪ Ski lifts and cable cars. ▪ All indoor and outdoor sports field. Professional sport ▪ Professional leagues without viewers and under specific rules. ▪ The primary condition is the mandatory testing of players before each event. Other N/A

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Public health measures and strategies to limit the spread of COVID-19 Health Information and Quality Authority

Table 3 Summary of current public health measures by country (extracted on 16 April 2021)

Denmark(42) Current Level: Risk Level 5 Effective from and to: 22/03/2021 – Various Movement of people ▪ The police regularly assess where there is a risk that many people will gather. These can include geographic areas, parks and squares. ▪ Areas are categorized as either hotspots, warning zones or no-go zones (residence bans), depending on the risk of many people gathering in the area. All of these areas should be avoided. ▪ The list of current hotspots, warning zones and residence bans is dynamic and subject to change. New areas may be added, and areas may be removed on the basis of dialogue between the police, municipalities, etc.

Hotspots ▪ Hotspots are areas where you can move freely, but where there is a risk that many people will gather. ▪ Citizens are encouraged to avoid staying in hotspots as much as possible.

Warning zones ▪ Warning zones are areas that you can move freely in, but where the police are extra present. ▪ Thus, stricter supervision is carried out in the warning zones, and if the development constitutes an increased risk of infection, temporary residence bans can be introduced in the zones.

Residence ban ▪ People must not stay in areas with a residence ban. ▪ Areas with a residence ban are areas where the police assess that there is a great risk that many people will gather, and it is therefore forbidden to stay in the area. ▪ It is allowed to pass through the area, but you are not allowed to stay. Social/mass gatherings Social or mass gatherings ▪ Assembly ban restricts gatherings to max 5 people, however, max 10 people if you are in a household together, are each other's closest relatives or in certain situations where your housing conditions so require. ▪ The assembly ban does not apply in private homes and gardens adjacent to it, which only the residents have at their disposal. ▪ The assembly ban does not cover activities for socially disadvantaged children and young people up to and including the age of 21. ▪ Recommendation of max 5 people in private homes incl. the household (unless the household is of more than 5 persons). ▪ The assembly ban does not apply to demonstrations. There is no upper limit to how many people can attend such events.

Church services (including funerals and weddings) ▪ The assembly ban does not apply to the Danish National Church and denominations outside the Danish National Church in premises that they have at their disposal when services are held. ▪ The religious act of wedding, funeral or confirmation can be carried out if it takes place inside the church or in the premises of the religious community. The requirements for floor area, interior design, information and good hygiene must, if applicable, be met, and in any case a max 500 people can be present at the same time. ▪ Outdoor weddings, baptisms or funerals have max 50 people.

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Table 3 Summary of current public health measures by country (extracted on 16 April 2021)

Denmark(42) Current Level: Risk Level 5 Effective from and to: 22/03/2021 – Various Business Activities Retail ▪ Department stores and grocery stores are open. However, different square meter requirements etc. apply. ▪ Department stores and department stores in shopping malls, arcades or bazaars of 15,000 m2 or less can reopen from 13 April 2021. ▪ Department stores and department stores in shopping malls, arcades or bazaars of more than 15,000 m2 must remain closed, but individual stores can stay open if there is direct street access. ▪ Grocery stores in closed shopping centres must, however, be open, just as they are open for picking up pre-ordered goods. Close sores can keep their premises open to sell goods to traders which the trader requires for their job, and for click and collect. ▪ Grocery stores, pharmacies, specialty stores with medical equipment, restaurants that sell takeaway as well as department stores where there is direct access to the store from the street can open, regardless of whether they are located in a shopping centre, etc. ▪ Post offices, parcel shops, parcel delivery points and shops may, regardless of whether they are located in a shopping centre, etc., can open for the purpose of collection and possible payment of parcels and goods that have been pre-ordered or prepaid. ▪ For retail premises under 2,000m2, an area of 7.5m2 must be provided per customer, however, 10m2 of available floor space is required for department stores. ▪ For retail premises between 2,000 and 4,999m2, an area of 10m2 must be provided per customer, however, 20m2 is required for department stores ▪ For retail premises between 5,000 - 9,999m2: 12m2 per. customer (max 500 customers). In department stores, however, a max of 250 customers who are present at the same time may be allowed access. ▪ For retail premises over 10,000m2: 25m2 per. customer, (max 833 customers). In department stores, a max of 250 customers who are present at the same time may be allowed if the customers present can document that they have booked an appointment in advance or if the department store has set up a fenced queuing system where the customers are supervised to ensure that they keep 2m distance.

Food and beverage ▪ Restaurants, bars, cafes and the like must stay closed. ▪ Takeaway available but between 10pm and 5am beverages with an alcohol content of more than 1.2% cannot be sold for takeaway.

Hotels ▪ Legally can stay open.

Personal services ▪ Can remain open unless there are local closures in the region, or if located in a large department store (>15,000m2) without direct street access. ▪ There is a requirement for customers to have corona passes (i.e. negative PCR test result <72 hours ago, or positive PCR test between 14 days and 12 weeks old, or proof of completed vaccinations). Primary schools ▪ Graduating students in primary schools can attend with 50% physical attendance (i.e. attend every other week) ▪ Students in 5th-8th class throughout the country can return with 50 percent. Physical attendance (every other week) ▪ Vulnerable students in 5th - 10th class must continue to show up with 100 per cent. Physical attendance ▪ Pupils at after-school centres, folk high schools, independent vocational schools and boarding schools at free and private schools are back for physical attendance subject to infection control measures. ▪ Staff and students from the age of 12 in primary school are strongly encouraged to have completed a test within the last 72 hours. However, no more than 2 weekly tests are needed. Secondary schools ▪ Graduating students in secondary can attend with 50% physical attendance (i.e. attend every other week) ▪ Students secondary education throughout the country can return with 50 percent. Physical attendance (every other week) ▪ Pupils at after-school centres, folk high schools, independent vocational schools and boarding schools at free and private schools are back for physical attendance subject to infection control measures.

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Public health measures and strategies to limit the spread of COVID-19 Health Information and Quality Authority

Table 3 Summary of current public health measures by country (extracted on 16 April 2021)

Denmark(42) Current Level: Risk Level 5 Effective from and to: 22/03/2021 – Various ▪ Students who live in boarding schools in upper secondary education can return to the boarding school in full when their education has reopened by 50% attendance ▪ Vocational education will reopen with full attendance for students who must participate in certificate subjects and for students in school internships throughout the country. ▪ Staff and students in secondary schools are strongly encouraged to have completed a test within the last 72 hours. However, no more than 2 weekly tests are needed. Higher and adult education ▪ Graduate students in higher education with many elements of practice can return with 50% physical attendance (every other week), unless the specific municipality is exempt from this. ▪ Other students in higher education can return with 20% physical attendance, including with first-year students as a special priority, unless the specific municipality is exempt from this. ▪ Students can meet physically in study groups, reading groups at libraries, etc. at the educational institutions with infection-reducing measures, unless the specific municipality is exempt from this. ▪ there will be requirements for students and staff to show up with a negative test result that is at most 72 hours old. Domestic travel ▪ Encouragement to travel outside rush hour and to walk or cycle on short journeys. (including transport) Culture/leisure/ Open entertainment ▪ Outdoor cultural institutions require visitors to present documentation for negative testing that is no more than 72 hours old. ▪ Unmanned solariums. ▪ Campsites (but take away restaurants only permitted on site). ▪ Outdoor swimming pools (max 10 people) or 50 allowed in total (if organised event).

Closed ▪ Concert venues. ▪ Indoor cultural institutions such as theatres, cinemas and museums. ▪ Discos and nightclubs. Amateur sport and ▪ The assembly ban for outdoor sports and association activities under organized auspices is max 50 people. recreation ▪ Golf (outdoors) with up to 10 persons present max (same household) and only 50 allowed in total on the golf course. ▪ Outdoor ice rink with up to 10 persons present max (same household) and only 50 allowed in total (if organised event) or 10 if not publicly organised.

Closed ▪ Gyms. ▪ Playgrounds. ▪ Indoor sports, association and leisure facilities. Professional sport ▪ Professional athletes may train indoors in rooms that are closed to the public. ▪ Professional athletes and the facilities used by the athletes before, during and after the completion of the sport are exempt from the small assembly ban. A max of 500 people may be present at a time. The number includes all persons present, including athletes, coaches, officials, etc. Other Regional restrictions ▪ The regions in Denmark may be at different levels of risk, and measures may be implemented geographically differently ensuring that the right combination of measures is implemented to keep infection down, while keeping society as open as possible. ▪ The measures will depend on where in society infections are and which measures the health authorities consider to be most effective. ▪ In Bornholm's Regional Municipality, on Christiansø and Frederiksø, 10 people may gather both indoors and outdoors.

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Table 3 Summary of current public health measures by country (extracted on 16 April 2021)

Denmark(42) Current Level: Risk Level 5 Effective from and to: 22/03/2021 – Various ▪ On non-bridged islands, primary schools (all grade levels including club offers) and continuation schools have reopened by 100% physical attendance.

Future measures (4 Phases of reopening) Phase 1: 6-13 April - shopping malls, department stores, arcades Phase 2: 21 April - large shopping malls, outdoor serving, museums, art galleries and libraries, organised sports for children and young people <18 Phase 3: 6 May - indoor dining, cultural activities and adult sports, possibly relaxation of home working Phase 4: 21 May - sports, leisure activities, full reopening of amusement parks, zoos, playgrounds, day colleges and evening schools.

Corona passes may be expanded to include terraces, which are due to reopen on 21 April, and restaurants, museums, theatres and cinemas from 6 May.

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Table 3 Summary of current public health measures by country (extracted on 16 April 2021) Finland (Northern Ostrobothnia, Southern Ostrobothnia, Central Current Level: Stable Effective from and to: Various – Various Ostrobothnia, Northern Savonia, Kainuu, Lapland)(40) Movement of people ▪ Work from home if possible. ▪ No restrictions on internal movement within Finland.

Social/mass gatherings Mass Gatherings ▪ General recommendation: No meeting of people outside of household unless absolutely necessary. ▪ General hygiene measures are binding in all areas where customers and participants are present. ▪ Regional variation, but in general, public events and general meetings for up to 20 people can be arranged if they comply with the hygiene and safety guidelines.

Funerals and weddings: ▪ Not reported. Business Activities Retail ▪ Most shops are open, but may have reduced opening hours and customer limits.

Food and beverages ▪ Restaurants are closed in many parts of the country until 18 April 2021. The restaurant lockdown is in effect in regions where the epidemic situation is the most serious. Grounds for closure will be examined weekly. ▪ Take away and delivery remain open.

Hotels ▪ Hotels and other accommodations are open with restrictions on alcohol sales. Primary schools ▪ Open for in-person learning but the municipality or regional government agency may close school premises when this is necessary to prevent the spread of COVID-19. ▪ Once the decision to close has been made, the education provider decides on the transition to exceptional teaching arrangements for basic education ▪ Exceptional teaching arrangements allow for distance learning as well as alternation between distance learning and contact teaching. Even if the school were to introduce exceptional teaching arrangements, in accordance with current legislation, the following would remain in contact teaching: - 1-3 students in classes - students who have received a special support decision - students with extended compulsory education - pupils in pre-primary education. Secondary schools ▪ Not full-time in-person learning currently, though there are plans to transition back during April. ▪ Local education provider can decide on teaching delivery (distance or multimodal) without a decision by the municipality or regional government agency to close the school. ▪ The municipality or regional administrative agency may close the premises of upper secondary schools or vocational schools when this is necessary to prevent the spread of a disease of general danger or an infectious disease which is reasonably suspected to be dangerous. Once the decision to close has been made, the education provider decides to move to exceptional teaching arrangements. Higher and adult education Not reported.

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Domestic travel No restrictions on internal movement within Finland. (including transport) Culture/leisure/ Children and young people entertainment ▪ Camps for children and young people are recommended to work in limited groups of up to 10 people. ▪ Group leisure activities for children under 12 years of age should not be restricted. Amateur sport and Not reported. recreation Professional sport Not reported. Other ▪ Restrictions may apply to a certain region or all of Finland. The regional restrictions and recommendations in place depend on the phase of the epidemic in the region in question. ▪ Municipalities may decide on assembly restrictions in their areas that are even stricter than those suggested by national government.

▪ From 19 April, restaurants in stable phase will reopen with the following restrictions: - 50% reduction in capacity in premises that primarily serve alcohol. - 25% reduction in capacity in all other restaurants. - Restaurants may serve alcoholic beverages until 10pm and be open to customers between 5 am and 11 pm. - In these regions, restaurants must instruct customers to stay seated in indoor premises. This means that dancing and karaoke, for example, are prohibited.

Roadmap for easing restrictions ▪ April – state of emergency ends The powers granted under the Emergency Powers Act will no longer apply. Transition to contact teaching (comprehensive school education and upper secondary education). Restaurants will open with certain restrictions; opening hours and the number of customers will still be restricted. Older people have received their first dose of the vaccine.

▪ May – strict restrictions lifted Restrictions imposed due to the threat of a fast acceleration of the epidemic will be removed; return to regional measures. Children and young people may take part in outdoor group hobbies. Public and private premises (incl. libraries and museums) will reopen. Commuter traffic within the EU will be possible. People in risk groups have received their first dose of the vaccine.

▪ June – regional restrictions gradually lifted Restrictions on gatherings will be eased. Restrictions on restaurants’ customer seating and opening hours will be eased. Adults may take part in outdoor group hobbies. Public events will resume with restrictions on the number of participants.

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Table 3 Summary of current public health measures by country (extracted on 16 April 2021) Finland (Northern Ostrobothnia, Southern Ostrobothnia, Central Current Level: Stable Effective from and to: Various – Various Ostrobothnia, Northern Savonia, Kainuu, Lapland)(40) Internal border control will end Vaccination coverage of working-age population having received their first dose of the vaccine is more than 50%.

▪ July – vaccination coverage increases Restrictions on gatherings will be eased and removed Restrictions on the number of participants in public events will be eased and removed Working-age population has received their first dose of the vaccine and older people and people in risk groups have received their second dose of the vaccine (July-August).

▪ August – vaccination coverage increases Commuter traffic to and from third countries will possibly resume.

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Social/mass gatherings Mass Gatherings ▪ General recommendation: No meeting of people outside of household unless absolutely necessary. ▪ Regional variation, but in general, public events and general meetings for a maximum of 10 people. ▪ The authorities may decide that activities in various spaces must be arranged so that no close contacts occur. This also applies to leisure activities.

Funerals and weddings: ▪ Not reported. Business Activities Retail ▪ Most shops are open, but may have reduced opening hours and customer limits.

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Table 3 Summary of current public health measures by country (extracted on 16 April 2021) Finland (Satakunta, Central Finland, Vaasa, Southern Savonia, Eastern Savonia, Current Level: Acceleration phase Effective from and to: Various – Various North Karelia, West Ostrobothnia)(40) Domestic travel ▪ The Finnish Transport and Communications Agency may also decide to restrict the number of passengers by a maximum of 50% during the Acceleration (including transport) phase. ▪ No restrictions on internal movement within Finland. Culture/leisure/ Children and young people entertainment ▪ Camps for children and young people are recommended to work in limited groups of up to 10 people. ▪ Group leisure activities for children under 12 years of age should not be restricted.

Cultural and leisure events ▪ The authorities may decide that activities in various spaces must be arranged so that no close contacts occur. This also applies to leisure activities. Amateur sport and Sporting events recreation ▪ The authorities may decide that activities in various spaces must be arranged so that no close contacts occur. This also applies to leisure activities. ▪ Municipalities and joint municipal authorities may also recommend suspending high-risk indoor group leisure activities for adults (aged 18 and over) and, where possible, carrying out the activities in online form. Leisure activities are considered high-risk if close contacts and the risk of droplet infection at close range cannot be avoided. Professional sport Not reported Other ▪ Restrictions may apply to a certain region or all of Finland. The regional restrictions and recommendations in place depend on the phase of the epidemic in the region in question. ▪ Municipalities may decide on assembly restrictions in their areas that are even stricter than those suggested by national government.

From 19 April, restaurants in acceleration/community transmission phase will reopen with the following restrictions: - 66% reduction in capacity in premises that primarily serve alcohol. - 50% reduction in capacity in all other restaurants. - Restaurants may serve alcoholic beverages between 7am and 5pm and be open to customers between 5am and 7pm. - In these regions, restaurants must instruct customers to stay seated in indoor premises. This means that dancing and karaoke, for example, are prohibited.

Roadmap for easing restrictions As above

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Social/mass gatherings Mass Gatherings ▪ General recommendation: No meeting of people outside of household unless absolutely necessary. ▪ Regional variation, but in general, public gatherings with more than six people are not allowed. ▪ Private events with more than six people should also be avoided.

Funerals and weddings: ▪ Not reported. Business Activities Retail ▪ Most shops are open, but may have reduced opening hours and customer limits.

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Table 3 Summary of current public health measures by country (extracted on 16 April 2021) Finland (All of the State of Southern Finland, Hospital district of Southwest Current Level: Community transmission Effective from and to: Various – Various Finland, Pirkanmaa, Åland)(40) Domestic travel ▪ The Finnish Transport and Communications Agency may also decide to restrict the number of passengers by a maximum of 50% during the Acceleration (including transport) phase. ▪ No restrictions on internal movement within Finland. Culture/leisure/ Children and young people entertainment ▪ Camps for children and young people are recommended to work in limited groups of up to 10 people ▪ Group leisure activities for children under 12 years of age should not be restricted. ▪Indoor activities for 12–18 year-olds should only be discontinued if they cannot be arranged in a way that complies with the guidelines. (max group of 10). If the epidemic situation deteriorates, the guidelines will also apply to leisure activities for children under 12 years of age.

Adults In areas that are in the community transmission phase, adult group activities should be temporarily suspended.

Cultural and leisure events ▪ The authorities may decide to close private commercial premises to customers, such as gyms, indoor playgrounds, swimming pools and dance halls. They may be closed for 2 weeks at a time. ▪ If necessary, municipalities may close their own facilities, such as public swimming pools, health centres or libraries, for a longer period of time. Amateur sport and Sporting events recreation ▪ The authorities may decide to close private commercial premises to customers, such as gyms, indoor playgrounds, swimming pools and dance halls. They may be closed for 2 weeks at a time. ▪ If necessary, municipalities may close their own facilities, such as public swimming pools, health centres or libraries, for a longer period of time. ▪ Group activities for adults may be suspended, in the case of children, it is important to consider the impact of restrictions. Professional sport Not reported. Other ▪ Restrictions may apply to a certain region or all of Finland. The regional restrictions and recommendations in place depend on the phase of the epidemic in the region in question. ▪ Municipalities may decide on assembly restrictions in their areas that are even stricter than those suggested by national government.

▪ From 19 April, restaurants in acceleration/community transmission phase will reopen with the following restrictions: - 66% reduction in capacity in premises that primarily serve alcohol - 50% reduction in capacity in all other restaurants - Restaurants may serve alcoholic beverages between 7am and 5pm and be open to customers between 5am and 7pm. - In these regions, restaurants must instruct customers to stay seated in indoor premises. This means that dancing and karaoke, for example, are prohibited. - Different restrictions will apply to restaurants in Aland region.

Roadmap for easing restrictions As above

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Table 3 Summary of current public health measures by country (extracted on 16 April 2021)

France(38) Current Level: Not reported Effective from and to: 03/04/2021 – 01/05/2021 Movement of people ▪ Movement is authorized within a radius of 10km around the home, with no daytime travel beyond 10km except for compelling or professional reasons (on presentation of certificate). ▪ Nationwide curfew in place from 7pm to 6am. ▪ Trips without derogatory certificates are prohibited from 7am to 6am. ▪ No inter-regional travel is authorized since 5 April, except for compelling reasons, including family reasons, for example to accompany a child to a parent ▪ Teleworking remains strongly recommended (with a recommendation to work at home at least 4 of every 5 days). Social/mass gatherings Mass Gatherings ▪ Groupings of more than six people indoors and outdoors are prohibited. ▪ No consumption of alcohol in public places. ▪ Max 6 people on public roads with the exception of protest demonstrations declared to relevant authorities.

Places of worship ▪ Worship services are allowed in accordance with a sanitary protocol and allowing 2 seats to be left free between each person or family entity and to occupy only 1 row out of 2.

Funerals ▪ Max 30 people at funeral ceremonies. ▪ Cemeteries will not close.

Weddings ▪ Weddings are allowed in accordance with a sanitary protocol and allowing 2 seats to be left free between each person or family entity and to occupy only 1 row out of 2. Business Activities Retail ▪ Essential shops are open, including bookshops, record stores, hairdressers, chocolate makers. ▪ Car dealers are open by appointment only. ▪ Shopping centres of more than 10,000 m² are closed. ▪ Pharmacies and food shops remain open, even in shopping centres of more than 10,000 m². ▪ Only food stores and pharmacies in shopping centres of more than 10,000 m² are open. ▪ Only food stores or those offering the sale of flowers, seeds, fertilizers, seeds and plants of fruit or vegetable species remain open in the open and covered markets. ▪ For closed shops, “click & collect” remains a possibility except for those located in shopping centres. ▪ To limit the concentration of flows and promote commercial activity, the possibilities of opening shops on Sundays are widened and establishments are encouraged to take advantage of additional opening possibilities during the lunch break.

▪ All shops and home services open until 7pm as part of a strict health protocol, and can re-open at 6am as part of curfew.

Restaurants and bars ▪ Remain closed. Restaurants open for take-away only.

Accommodation ▪ Hotels can remain open but hotel restaurants and bars must remain closed, while maintaining a “room service” activity.

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Table 3 Summary of current public health measures by country (extracted on 16 April 2021)

France(38) Current Level: Not reported Effective from and to: 03/04/2021 – 01/05/2021 Other services ▪ Real estate visits are allowed

Primary schools ▪ Currently on three weeks of remote learning/holidays with plans to return to face-to-face learning from week of April 26.

Secondary schools ▪ Currently on 4 weeks of remote learning/holidays with plans return to face-to-face learning from week of May 3.

Higher and adult education ▪ Currently on 4 weeks of remote learning/holidays with plans return to face-to-face learning from week of May 3. ▪ Universities continue to operate according to the protocols in force, i.e. the possibility for each student to go to the university 1 day per week. ▪ Exams scheduled until May 3 will be maintained and their organization will be adapted. Exams that cannot be done via distance will have to be postponed as much as possible to the month of May. Domestic travel ▪ Movement is authorized within a radius of 10km around the home, with no daytime travel beyond 10km except for compelling or professional reasons (on (including transport) presentation of certificate). Culture/leisure/ Open entertainment ▪ Parks and gardens. ▪ Beaches, lakes and bodies of water. ▪ Libraries, archives, and bookstores. ▪ Galleries. ▪ Artistic establishments relating to performing arts and plastic arts, in particular music schools and conservatories, are authorized to accommodate underage students, except for singing lessons.

Closed ▪ Theatres, shows and cinemas although professional artists wishing to rehearse or to record can go these establishments. ▪ Play centres. ▪ Zoos. ▪ Sports halls, casinos, gaming rooms, fairs. ▪ Nightclubs. ▪ Winter sports resorts. Amateur sport and ▪ Children’s sports activities may continue but must take place near or within the school premises. recreation ▪ Individual outdoor sports activities permitted, within 10km radius. ▪ Extra-curricular outdoor activities permitted, within 10km radius. ▪ Amateur sports competitions are suspended. ▪ Sports halls are closed for amateurs, however amateur athletes can join a sports facility (uncovered sports grounds, arenas or racetracks) located in their Department (or 30km within a neighbouring Department) Professional sport ▪ Professional sports competitions can take place but must be done behind closed doors. Other ▪ Specific local area restrictions may also be in place. ▪ Week of April 26: start of the school year, with face-to-face return for nursery / primary and distance courses for colleges / high schools. ▪ Week of May 3: return to class for colleges / high schools, respecting with appropriate attendance gauges. ▪ There will be gradual reopening of cultural activities according to a strict health protocol, from mid-May.

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Table 3 Summary of current public health measures by country (extracted on 16 April 2021)

Germany(49) Current Level: Not reported Effective from and to: Various – 18/04/2021 Movement of people ▪ People are asked to refrain from non-essential travel for personal reasons and from visiting people, including relatives. ▪ Home working has been extended until 30 April. Social/mass gatherings Social gatherings ▪ Advised to limit contact with people as far as possible. ▪ Private get-togethers with friends, relatives and acquaintances limited to your own household and to one other household, but in any case max 5 people. Children up to 14 years of age are generally exempt from this. In the state of Berlin, for example, only children up to the age of 12 are exempt from the contact restrictions. ▪ If the 7-day incidence in a region is below 35 new infections per 100,000 inhabitants, 3 households with a max of 10 people can come together. Children up to the age of 14 are not counted. ▪ If the 7-day incidence in a federal state or region rises to over 100 per 100,000 inhabitants on 3 consecutive days, the contact restriction is tightened again. A private get-together is then limited to your own household and 1 other person.

Religious celebrations ▪ Special religious celebrations such as baptisms, circumcisions and weddings as well as funeral services may take place in small groups. The details are regulated by the respective federal states. ▪ Religious acts that attract large numbers of visitors should be avoided (for example pilgrimages or processions). ▪ Congregation and choir singing as well as orchestral accompaniment are not recommended. Business Activities Retail ▪ The retail trade will generally remain closed until April 18, 2021. Exceptions are grocery stores, pick-up and delivery services, beverage stores, pharmacies and drug stores, baby specialty stores, medical and health food stores, opticians, hearing aid acousticians, banks and savings banks, post offices, dry cleaners and laundromats. ▪ Newspapers, animal supplies and feed can be resold. ▪ The sale of non-food products is restricted. ▪ If open, a facility with a sales area of up to 800 square meters should have a maximum of one person per 10 square meters of sales area. For larger shops, greater than 800m2, one person is allowed for every additional 20m2 of sales area.

Personal services ▪ Hairdressers open. ▪ Personal services open - if a mask cannot be worn during the services (such as with cosmetic facial treatments) a daily negative rapid test must be presented.

Food and beverage ▪ Restaurants and cafés, as well as bars, pubs and similar establishments closed. ▪ Exceptions are permitted for the delivery and collection of food that can be taken away and consumed at home, and for the operation of canteens.

Accommodation ▪ Accommodation in Germany will now only be provided for necessary and explicitly non-tourism purposes.

Others ▪ Bookshops open. ▪ Flower shops and garden centres open with hygiene measures and customer restrictions. ▪ Driving and flight schools open but students must have a negative test.

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Table 3 Summary of current public health measures by country (extracted on 16 April 2021)

Germany(49) Current Level: Not reported Effective from and to: Various – 18/04/2021 Primary schools ▪ Elementary schools are open with some schools rotating face-to-face and distance learning. ▪ Measures vary between states. Secondary schools ▪ Secondary school students undertaking state exams this year have returned to the classroom. ▪ Measures vary between states with some returning all together and others doing so on rotation. Higher and adult education ▪ Distance learning. Domestic travel ▪ People are asked to generally refrain from non-essential travel for personal reasons and from visiting people, including relatives. (including transport) Culture/leisure/ Open entertainment ▪ Zoos, zoological gardens, animal parks, museums and galleries can open if there is a 7-day incidence of less than 50 new infections per 100,000 in a region. ▪ These facilities can open where incidence is >50/100,000 inhabitants provided an appointment is made and visitors are documented.

Closed ▪ Institutions and facilities classified as recreational including theatres, cinemas, amusement parks, amusement arcades, brothels, and similar facilities. ▪ Clubs, discotheques, and similar establishments. ▪ Events for the purposes of entertainment are prohibited. Amateur sport and ▪ Individual sport engaged in alone, in pairs or with your own household is permitted. recreation ▪ Institutions and facilities classified as recreational are closed including gyms and similar facilities, recreational and amateur sport in all public and private sports venues. ▪ For regions with a 7-day incidence below 50, max 10 people can meet outdoors for non-contact sport. ▪ In places with an incidence between 50 and 100, two households with max 5 people can meet for exercise. Professional sport ▪ Professional sports events may only take place without spectators. Other The federal and state governments have agreed on five steps to reopen society. The country should be able to relax the applicable measures depending on the development of the infection rate. ▪ Step 1: 1 March - schools, daycare centres and hairdressers ▪ Step 2: 8 March - bookstores and personal services ▪ Step 3: 8 March - retail museum and outdoor sports dependant on the infection rate ▪ Step 4: outdoor catering, theatre and sports - date dependant on the infection rate ▪ Step 5: leisure events, retail and sports - date dependent on infection rate.

▪ Proposals from Federal Government which are due to be voted on imminently include night curfews from 9pm to 5am and the closure of schools and businesses if 7-day incidence rates top 100 infections per 100,000 residents over 3 consecutive days.

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Table 3 Summary of current public health measures by country (extracted on 16 April 2021)

Ireland(33) Current Level: Level 5 Effective from and to: 12/04/2020 – Various Movement of people ▪ Travel within own county or within 20km of home if crossing county boundaries is now permitted ▪ Work from home unless essential for work, which is an essential health, social care or other essential service and cannot be done from home.

Social/mass gatherings In your home or garden ▪ No visitors permitted in private homes or gardens except for essential family reasons such as providing care to children, elderly or vulnerable people, or as part of a support bubble. ▪ If 2 weeks have passed since the second dose of the vaccine has been administered (hence fully vaccinated), 2 fully vaccinated individuals from 2 different households can meet indoors without wearing masks or staying 2 metres apart.

Other settings outside your home or garden ▪ Two households can meet outside but not in a private garden

Organised outdoor gatherings ▪ No organised outdoor gatherings should take place.

Organised indoor gatherings ▪ No organised indoor gatherings should take place.

Religious services ▪ Services online. ▪ Places of worship open for private prayer.

Weddings ▪ Max 6 guests.

Funerals ▪ Max 10 mourners.

Business Activities Retail and services (for example, hairdressers, beauticians, barbers) ▪ All retail closed except for essential retail. ▪ All non-essential services closed. ▪ Click and collect for non-essential retail outlets not permitted.

Food and beverage (including hotel restaurants and bars) ▪ Take away food and delivery only.

Accommodation ▪ Open only for essential non-social and non-tourist purposes.

Wet pubs ▪ Closed. Primary schools ▪ Open for face-to-face teaching for all classes.

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Table 3 Summary of current public health measures by country (extracted on 16 April 2021)

Ireland(33) Current Level: Level 5 Effective from and to: 12/04/2020 – Various

Secondary schools ▪ Open for face-to-face teaching for all years.

Higher and adult education ▪ Higher, further and adult education should remain primarily online. Domestic travel ▪ Walk or cycle where possible. (including transport) ▪ Avoid public transport - except for essential workers and essential purposes only. ▪ Public transport capacity will be restricted to 25%.

Culture/leisure/ Open entertainment ▪ Libraries will be available for browsing, e-services, and call and collect. No seating or events. ▪ Outdoor playgrounds, play areas and parks.

Closed ▪ Nightclubs, discos and casinos. ▪ Museums, galleries and other cultural attractions. Amateur sport and Exercise and sport recreation ▪ People may meet with people from 1 other household in outdoor settings when taking exercise. ▪ No indoor or outdoor exercise group activities, including those involving children. ▪ Outdoor golf and tennis are not permitted. ▪ Individual training only. ▪ No exercise or dance classes.

Gyms, leisure centres and swimming pools ▪ Gyms, leisure centres and swimming pools closed. Professional sport ▪ Professional and elite sports, horse-racing and greyhound racing are permitted to continue behind closed doors. ▪ No other matches or events are to take place.

Other Advised changes to restrictions ▪ From 19 April, adult intercounty GAA and elite athlete training to commence ▪ From 26 April (subject to prevailing public health situation), outdoor sports facilities can reopen, outdoor attractions can reopen, underage non-contact outdoor training in pods of 15 or less can resume, and funeral attendance will increase to 25. ▪ Under consideration from 4 May (subject to prevailing public health situation), Full reopening of construction activity, phased return of non-essential retail commencing with click and collect and outdoor retail, recommencement of personal services on a staggered basis, reopening of museums, galleries and libraries, recommencement of religious services on a staggered basis.

▪ The situation will be subject to ongoing review taking account of the evolving epidemiological situation and available evidence in relation to vaccine deployment, uptake and effectiveness.

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Table 3 Summary of current public health measures by country (extracted on 16 April 2021) Italy(10) (Regions of Sardinia, Puglia, Current Level: Red area (maximum risk) Effective from and to: 06/04/2021 –30/04/2021 Campania, Val d'Aosta) Movement of people ▪ Curfew from 10pm to 5am. ▪ Forbidden to travel within one's own municipality, from one municipality to another and from one region to another, except for reasons of work, urgent matters, and health. ▪ Strongly recommended to refrain from travelling by public or private means of transport, with the exception of work, study and health related reasons, any urgent matters, or when carrying out activities or using services that are still available. Social/mass gatherings Gatherings ▪ Travel to private dwellings other than one's own are not allowed, unless they are due to work, necessity or health reasons. ▪ Gatherings of people in public places or places open to the public is forbidden.

Religious services ▪ Religious functions with the participation of people can be carried out, as long as they comply with the protocols signed by the Government with their respective confessions. ▪ Burials are allowed respecting the interpersonal distance of 1metre between those assisting at the burial. Business Activities Retail ▪ Closed, except for supermarkets, food, newsstands, tobacconists, pharmacies and parapharmacies. Home delivery is permitted.

Food and beverage ▪ Closed 7 days a week. ▪ Take-away from 5am until 6pm allowed without restrictions. ▪ Take-away from 6pm until 10pm not allowed for businesses whose main activity is without a kitchen or is retail trade in beverages. ▪ Home delivery is allowed at any time

Hotels Hotel restaurants are open to guests staying there.

Markets Closed, except for activities aimed at the sale of foodstuffs, agricultural and horticultural products only. Primary schools ▪ Primary schools are open ▪ School related activities (e.g. after-school programmes) can resume for those returning to school. Secondary schools ▪ Distance learning for all years except first year of secondary school, students with disabilities and special educational needs, or where practical laboratory classes are required. ▪ School related activities (e.g. after-school programmes) can resume for those returning to school. Higher and adult education ▪ Distance learning, but individual universities can identify specific programmes that may avail of in-person learning, subject to compliance with protocols. Domestic travel ▪ Forbidden to travel from one region to another and from one municipality to another, even within one's own municipality, except for reasons of work, (including transport) urgent matters, and health. Culture/leisure/ Open entertainment ▪ Libraries

Closed

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Table 3 Summary of current public health measures by country (extracted on 16 April 2021) Italy(10) (Regions of Sardinia, Puglia, Current Level: Red area (maximum risk) Effective from and to: 06/04/2021 –30/04/2021 Campania, Val d'Aosta) ▪ Museums and exhibition halls. ▪ Theatres and cinemas, although spaces can be used to stream events. ▪ Amusement arcades, betting rooms and bingo facilities (also in bars and tobacco shops). Amateur sport and ▪ Exercise in proximity of home and individual outdoors sports activities are allowed. recreation ▪ All contact sport is suspended ▪ All sports competitions suspended. ▪ Activities in sports centres suspended. ▪ Gyms closed. ▪ Hunting is forbidden. ▪ In the red area it is allowed to carry out sports activities exclusively within the territory of one's own Municipality, from 5.00 to 22.00, individually and outdoors. Professional sport ▪ Those recognised as being of national interest by the International Olympic Committee and the Italian Paralympic Committee. Other Planned easing of restrictions ▪ People can enjoy al fresco dining from April 26. ▪ Swimming pools will reopen from May 15. ▪ Some activities in gyms will reopen from June 1. ▪ Trade shows can recommence from July 1.

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Table 3 Summary of current public health measures by country (extracted on 16 April 2021) Italy(10) Current Level: Orange area (high risk) Effective from and to 06/04/2021 – 30/04/2021 (All other regions in Italy) Movement of people ▪ Curfew from 10pm to 5am, unless there are proven reasons for work, necessity, and health, with the recommendation not to travel except for health, work, study reasons or urgent matters. ▪ Movements to other municipalities are allowed only for proven work needs, situations of necessity or health reasons. ▪ Strongly recommended to refrain from travelling by public or private means of transport, with the exception of work, study and health related reasons, any urgent matters, or when carrying out activities or using services that are still available. Social/mass gatherings Gatherings ▪ Visits by up to 2 people to another private home are allowed, once a day between 5am and 10pm, in the same Region or Autonomous Province. The person or 2 people can also bring children under 14, disabled or non-self-sufficient people living with them. ▪ People who live in a municipality with up to 5,000 inhabitants are also allowed to move, between 5am and 10pm, within 30 km from the border of their municipality (therefore possibly also into another region or autonomous province) ▪ Gatherings of people in public places or places open to the public is forbidden.

Religious services ▪ Religious functions with the participation of people can be carried out, as long as they comply with the protocols signed by the Government with their respective confessions. ▪ Burials are allowed respecting the interpersonal distance of 1metre between those assisting at the burial. Business Activities Retail ▪ Open but on public holidays and pre-holidays, the shops inside the shopping centres and markets are closed except for pharmacies, parapharmacies, food shops, tobacconists, and newsagents inside the shopping centres.

Hotels Hotel restaurants are open to guests staying there. Primary schools ▪ Primary schools are open. ▪ School related activities (e.g. after-school programmes) can resume for those returning to school. Secondary schools ▪ In-person learning for all students in lower secondary school (middle schools), students with disabilities and special educational needs, or where practical laboratory classes are required. ▪ For upper secondary schools (high schools, technical institutes etc.), between 50% and 75% of student population should be in school, while the remainder use remote learning. ▪ School related activities (e.g. after-school programmes) can resume for those returning to school. Higher and adult education ▪ Distance learning but based on the progress of the epidemiological framework, universities can make plans for the organisation of teaching and curricular activities to be carried out remotely or in person. Domestic travel ▪ Movements to other municipalities are allowed only for proven work needs, situations of necessity or health reasons. (including transport) ▪ Strongly recommended to refrain from travelling by public or private means of transport, with the exception of work, study and health related reasons, any urgent matters, or when carrying out activities or using services that are still available. Culture/leisure/ Open entertainment ▪ Libraries

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Closed ▪ Museums and exhibition halls. ▪ Theatres and cinemas, although spaces can be used to stream events. ▪ Amusement arcades, betting rooms and bingo facilities (also in bars and tobacco shops). Amateur sport and ▪ Exercise in proximity of home and individual outdoors sports activities are allowed. recreation ▪ All contact sport is suspended ▪ All sports competitions suspended. ▪ Activities in sports centres suspended. ▪ Gyms closed. ▪ Hunting is allowed but only within own municipality. ▪ It is possible to go to another Municipality, from 5.00 to 22.00, to do sports only if this is not available in a person's Municipality (for example, if there are no tennis courts), as long as it is in the same Region or Province autonomous. Professional sport ▪ Those recognised as being of national interest by the International Olympic Committee and the Italian Paralympic Committee. Other Planned easing of restrictions ▪ People can enjoy al fresco dining from April 26. ▪ Swimming pools will reopen from May 15. ▪ Some activities in gyms will reopen from June 1. ▪ Trade shows can recommence from July 1.

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Table 3 Summary of current public health measures by country (extracted on 16 April 2021)

Netherlands(34) Current Level: Severe Level 4 – national lockdown Effective from and to: Various – At least 28/04/2021

Movement of people ▪ Curfew between 10pm and 4.30am. ▪ If people go outdoors during this time without having a valid reason to do so, they risk a €95 fine. ▪ Stay at home, and work from home, as much as possible. Social/mass gatherings Households ▪ Max 1 visitor per day to your house (excluding children under 13). ▪ Visit no more than 1 other household per day.

Outdoors ▪ Max 2 people or 1 household in a group.

Events ▪ Events are generally banned and most indoor locations are currently closed. ▪ At locations that are open, max 30 people provided everyone can keep 1.5m apart.

Funerals ▪ Max 50 mourners. Business Activities Retail ▪ Shops selling essentials, including supermarkets, greengrocers and chemists, may remain open. ▪ Shops selling mainly groceries may remain open until 10pm. While the curfew is in force, these shops must close no later than 9.45pm and open no earlier than 6am. ▪ Shops selling non-food essentials must close no later than 8pm and open no earlier than 6am. ▪ Shops may not sell alcoholic drinks between 8pm and 6am. ▪ Non-essential shops closed but shopping by appointment (See below), ‘click and collect’ and delivery allowed.

Shopping by appointment ▪ Shops allowed to admit 2 customers per floor or 1 customer per 25m2, up to max 50 customers at a time, if the shop is big enough. ▪ Appointments must be made at least 4 hours in advance and each customer slot must be a min of 10 minutes.

Personal services ▪ People working in contact-based professions, like hairdressers and driving instructors, can perform their work.

Food and beverage ▪ All establishments that serve food and drinks, including bars, cafes and restaurants must remain closed. Exceptions are: hotels serving hotel guests, funeral locations, airports (after security). ▪ Take-away will still be possible. ▪ Alcoholic drinks may not be picked up from takeaway restaurants after 8pm.

Accommodation ▪ Hotels are open, but it is not possible to order food or room service in the hotel. Any food must be eaten in the hotel room.

Markets

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Netherlands(34) Current Level: Severe Level 4 – national lockdown Effective from and to: Various – At least 28/04/2021

Outdoor sales are only permitted for (weekly) markets and flower sales that require a permit. Only stalls for food (food and drinks) are allowed on a (weekly) market. The exact decision as to which stalls may or may not be on a commodity market is made by the municipality. Primary schools ▪ Open for face-to-face teaching. Secondary schools ▪ Partially open for face-to-face teaching. ▪ Students are at school at least 1 day a week. ▪ Students are allowed to go to school for practical lessons and exams. ▪ Students in a vulnerable position are allowed to go to school for guidance. Higher and adult education ▪ Remote teaching. ▪ Students are allowed to go to college or university for practical lessons and exams. ▪ Students in a vulnerable position are allowed to go to college or university for guidance Domestic travel ▪ Travel as little as possible. (including transport) ▪ Use public transport for essential travel only. ▪ Stay in the Netherlands. Do not travel abroad in the period up to and including 15 May. Culture/leisure/ Open entertainment ▪ Small-scale, not-for-profit, managed outdoor playgrounds. ▪ Libraries and community centres only for collection and return of books and to support vulnerable people, including organised daytime activities and youth work (max 30 people). ▪ Rehearsals and recordings by professional performing artists for online performances, can go ahead. ▪ Secondary schools can receive cultural education in locations such as theatre that are otherwise closed to the public.

Closed ▪Theatre, concert halls, cinemas and casinos ▪ Zoos and amusement parks. Amateur sport and Adults recreation ▪ Only outdoor sports allowed. ▪ Adults aged 18 to 26 can participate in team sports outdoors at sports facilities without staying 1.5m apart. ▪ Adults aged 27 and over can participate in sports activities at outdoor sports facilities in groups of up to 4 people. They must stay 1.5m apart. ▪ All indoor sports facilities remain closed. ▪ Matches and competitions are not allowed.

Children ▪ Children aged 12 and under can attend swimming lessons to achieve their A, B or C diplomas. ▪ Children up to and including 17 years old are allowed to exercise outside with their team. They are allowed to play matches with each other A, B or C diplomas. ▪ Children can participate in team sports outdoors at sports facilities. Professional sport ▪ Elite athletes with a status at assigned locations (such as the National Sports Centre); footballers (including support staff in a ‘bubble’) in the Premier and Frist Divisions may take part in group sports. Other ▪ The out-of-school care (out-of-school care) will reopen for all children on 19 April ▪ There is a 6 step plan to reopening society starting on 26 April, dependent on the numbers of people with COVID-19 admitted to hospital. ▪ Step 1: 26-28 April

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Netherlands(34) Current Level: Severe Level 4 – national lockdown Effective from and to: Various – At least 28/04/2021

- terraces and shops to open - End of curfew - Meet max. 2 people at home - Catering outside open - Retail open

▪ Step 2: 11 May - Open flow locations outside - Sports allowed indoors - Art and culture practice allowed indoors - Extensions to Sports outdoors - Access tests allowed

▪ Step 3: May 26 - Meet up to 4 people at home - Group size max. 4 people - Open flow locations inside - Catering industry open for dining out - Cultural institutions open - Extensions to Sports indoors and outdoors

▪ Step 4: June 16 - Meet max. 6 people at home - Group size max. 6 people - Other catering open - Events allowed - Extensions to Catering for dining out, Cultural organizations, Sports indoors and outdoors

▪ Step 5: July. - Meet up to 8 people at home - Group size max. 8 people - Extensions to Catering for dining out, Other catering, Events, Cultural organizations & Sports indoors and outdoors

▪ Step 6: No date yet - End of measures

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Portugal(35) Current Level: Severe – General State of Emergency Effective from and to: 15/03/2021 – 30/04/2021 Movement of people ▪ Stay at home, leave only for the essentials. ▪ Teleworking is mandatory where feasible. Social/mass gatherings Events ▪ Not permitted.

Places of worship & religious ceremonies ▪ Permitted with reduced capacity according to local Health Authority rules.

Weddings and baptisms ▪ Not permitted.

Business Activities Retail ▪ Stores up to 200 m2 with a door to the street can open, as well as stores offering essential goods and services ▪ Grocery stores can operate until 9pm on weekdays and until 7pm on weekends and holidays. ▪ All other establishments can operate until 9pm on weekdays and until 1pm on Saturdays, Sundays and holidays. ▪ No more than 5 people are allowed for 100m2

Restaurants ▪ Terraces serving food can open (max 4 people per table) ▪ All other restaurants are closed

Bars and Nightclubs ▪ Closed.

Hotels ▪ Hotels, tourist establishments, local accommodation establishments can remain open, as well as those establishments that guarantee student accommodation. ▪ Bars and restaurants of the hotels can function for room service or take-away.

Personal services ▪ Hairdressing salons, barbers, beauty salons and similar establishments are allowed to operate by appointment only.

Markets ▪ Fairs and non-food markets can open (by municipal decision). Primary schools ▪ Schools are open up to and including the 6th grade. ▪ Resumption of after school activities for the same age group.

Secondary schools ▪ Distance learning with limited exceptions as follows: - students needing therapeutic support - children of essential service workers

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Portugal(35) Current Level: Severe – General State of Emergency Effective from and to: 15/03/2021 – 30/04/2021 - students at risk or danger signalled by the child and youth protection commission and whose school considers distance learning ineffective and they are in particular danger of school dropout. Higher and adult education ▪ Distance learning only. Domestic travel ▪ Public transport continues to operate with the necessary adjustments to serve the population. (including transport) ▪ Public transport operates at maximum two-thirds capacity. Culture/leisure/ Open entertainment ▪ Bookstores, libraries and archives. ▪ Museums, monuments, palaces, art galleries and similar. ▪ Parks, gardens, green spaces and leisure areas.

Closed ▪ Cinemas and theatre.

Amateur sport and Open recreation ▪ Low risk sports activities are permitted including outdoor physical activity with up to 4 people and gyms without group classes. ▪ Golf courses and swimming pools are open.

Closed ▪ Leisure centres.

Professional sport ▪ Training and competitive activities for athletes from national Olympic and Paralympic teams, from the 1st national division, from competitions of corresponding competitive level, as well as for international championships are permitted within guidelines. ▪ Public attendance not allowed. Other Advised changes to restrictions. The Government has established an easing plan, crossing several scientific criteria, divided into 4 phases and with a period of 15 days between each phase, in order to be able to assess the impacts of the measures on the evolution of the pandemic.

1st Phase Restrictions lifted on March 15 but maintained until April 30 in the municipalities of Moura, Odemira, Portimão and Rio Maior - Opening of commercial establishments until 9:00 pm on working days and until 1:00 pm on weekends and public holidays, for home delivery, door-to-door delivery of goods or collection of products purchased by means of remote communication (click and collect). - Food stores open until 9 p.m. on working days and until 7 p.m. on Saturdays, Sundays and public holidays. - The sale of take-away drinks is allowed in restaurants and similar establishments, but the sale of alcoholic beverages is prohibited between 8 pm and 6 am - Fairs and food markets are allowed, with the authorization of the city council. - Opening of bookstores, libraries and archives. - Opening of parks, gardens, green spaces and leisure areas. - The time restriction is not applicable to accommodation units, local accommodation, rent-a-car and establishments located inside airports after the passenger security check. - In hotel bars and restaurants, operation is permitted for the purpose of room-service or take-away. Portuguese citizens are allowed to travel outside the mainland, by road, rail, air, river or sea.

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Portugal(35) Current Level: Severe – General State of Emergency Effective from and to: 15/03/2021 – 30/04/2021 2nd Phase Restrictions lifted on April 5 but maintained until April 30 in the municipalities of Alandroal, Albufeira, Carregal do Sal, Figueira da Foz, Marinha Grande and Penela - opening of museums, monuments, palaces, art galleries and similar - opening of shops up to 200 m2 with a door to the street - non-food fairs and markets allowed upon municipal decision - opening of terraces (groups of maximum 4 people allowed) - physical activity and outdoor training up to 4 people - opening of swimming pools - opening of golf courses.

3rd Phase From April 19, except in the municipalities of Moura, Odemira, Portimão and Rio Maior (maintain restrictions of the 1st phase), Alandroal, Albufeira, Carregal do Sal, Figueira da Foz, Marinha Grande and Penela (maintain restrictions of 2nd phase) - opening of cinemas, theatres, auditoriums, concert halls - opening of all shops and shopping centres - opening of restaurants, cafes, and bakeries until 10 pm on working days and until 1 pm on weekends and public holidays. Groups of 4 people are allowed inside or 6 people on terraces - physical activity and outdoor training up to 6 people - outdoor events allowed with reduced attendance.

4th Phase From the 3rd of May - Opening of restaurants, cafés, and pastry shops with no time limit. Groups of 6 people are allowed inside or 10 people on terraces - Large outdoor and indoor events allowed with reduced occupancy

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Table 3 Summary of current public health measures by country (extracted on 16 April 2021)

Spain(39) Current Level: National State of Alarm Effective from and to: 27/10/2020 – 09/05/2021 Movement of people ▪ A nationwide curfew between 11pm and 6am with a number of exceptions. ▪ Each regional government may modify the start from between 10pm and midnight and the end from between 5am and 7am. ▪ Each regional government may decide on limitations on the arrival to and departure from their regions, which may cover the whole or part of the region. ▪ Each regional government may limit gatherings in public or private spaces to a max of 6 people unless from the same household. ▪ Covers the whole country including the Canary Islands. Social/mass gatherings General gatherings ▪ Each regional government may limit gatherings in public or private spaces to a max of 6 people unless from the same household. ▪ Prohibition on smoking/eating/drinking on public roads when it is not possible to maintain a safe distance

Places of worship, funerals, wakes, weddings ▪ Generally permitted but with reduced capacity and varies by Region. ▪ Weddings and other ceremonies such as baptisms may be postponed in Alert Level 4.

Business Activities Food and beverages ▪ Many restaurants, bars and cafes are open, particularly outdoors, but generally have limited opening hours and may have reduced capacity. Varies by region

Retail ▪ Generally open but varies by region.

Accommodation ▪ Generally open, but limited availability and varies by region.

Primary schools ▪ Open for face-to-face teaching. Secondary schools ▪ Open for face-to-face teaching. Higher and adult education ▪ Restricted face-to-face learning. Varies by University. Domestic travel ▪ Regions will also have the authority to restrict the entrance to and exit from their territories unless this is for essential reasons such as going to work or to (including transport) get to the doctor. ▪ This would allow regions to close their borders should they have a neighbouring territory that is particularly hard hit by the virus.

Culture/leisure/ ▪ Max 6 people for any activity or event of a social nature, both on public roads and in public and private spaces, unless from the same household. entertainment Cinemas, museums and indoor attractions ▪ Varies by Region. If cultural establishments are open, visitors must be registered.

Parks and outdoor amusements ▪ Generally open, but varies by region ▪ Prohibition of public alcohol consumption

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Table 3 Summary of current public health measures by country (extracted on 16 April 2021)

Spain(39) Current Level: National State of Alarm Effective from and to: 27/10/2020 – 09/05/2021 Beaches and swimming pools ▪ Generally open, but with reduced capacity, and varies by region

Amateur sport and Sports facilities recreation ▪ May be open at reduced capacity but varies by Region

Individual outdoor physical activity ▪ Permitted Professional sport ▪ Risk assessment required. Other ▪ Measures vary between regions, and based on alert levels at a very local level.

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Table 3 Summary of current public health measures by country (extracted on 16 April 2021)

Sweden(50) Current Level: Unreported Effective from and to: Various - Various Movement of people ▪ Only employees who must be physically present to carry out their work should be present on authorities' premises (until 31 May). Social/mass gatherings Public gatherings and events ▪ As of 12 March and until further notice, it is forbidden in the whole of Sweden to hold public gatherings and events with more than 500 participants. ▪ Max 8 people at public gatherings and events until further notice. ▪ If a private gathering is held at an event venue, in a meeting room and at other rented premises, a maximum of eight people are allowed to attend. ▪ Public gatherings include: - gatherings that constitute demonstrations or which are otherwise held for discussion, expression of opinion or providing information on public or private matters - lectures and speeches held for the purposes of teaching or for public or civic education - gatherings for religious practice - theatrical and cinema performances, concerts and other gatherings for the performance of artistic work, and circus performances - other gatherings at which freedom of assembly is exercised. ▪ Public events include: - competitions and exhibitions in sports and aviation - dance performances - fairground amusements and parades - markets and fairs - other events not regarded as public gatherings. Schools, public transport, private events and visits to shops are excluded.

Fully vaccinated individuals ▪ 2 weeks after having received the second dose of vaccine, a fully vaccinated older person may meet with asymptomatic relatives without social distancing.

Funeral services ▪ Max 20 people permitted at funerals services. Business Activities Retail ▪ Open. ▪ Max of 500 people may simultaneously visit a department store or shop, but this rule does not apply to shopping centres or malls.

Food and beverage ▪ Dining party size at any 1 table limited to max 4 people. If a party is larger than 8 people, they must be divided between several tables with at least 1m between them. ▪ Food and drink can only be served to guests who are seated at a table or a bar counter. ▪ Venues serving food and drink must close no later than 8.30pm. Takeaway can be offered after 8.30pm. ▪ The serving of alcoholic beverages and alcoholic beverage-like preparations is prohibited between 8pm and 11am. ▪ Any catering establishment that is located in a shopping centre, such as shopping malls, can only serve customers eating alone. If a catering establishment has its own entrance, the limit of 1 person per party does not apply. ▪ Businesses can supply food for collection (take-away).

Primary schools ▪ Open for face-to-face teaching.

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Table 3 Summary of current public health measures by country (extracted on 16 April 2021)

Sweden(50) Current Level: Unreported Effective from and to: Various - Various Secondary schools ▪ Open for face-to-face teaching. ▪ Teaching at the country's upper secondary schools may be conducted as a combination of distance education or distance education and face-to-face education. Higher and adult education ▪ All forms of education above upper secondary school level are to be regarded as workplaces because the students are adults. ▪ The same applies to education at upper secondary level within folk high schools and municipal adult education. ▪ At present, everyone who can is encouraged to work from home, which means that the starting point for these educations is distance learning.

Domestic travel ▪ Avoid public transport and other means of transport where it is not possible to book a seat. (including transport) ▪ On buses and trains that have line distances of more than 150 km, the number of passengers may not be more than half of the vehicle's seat capacity. Culture/leisure/ ▪ Max 8 people at public gatherings and events until further notice. entertainment ▪ If a private gathering is held at an event venue, in a meeting room and at other rented premises, a max of 8 people are allowed to attend. ▪ Public gatherings include theatrical and cinema performances, concerts and other gatherings for the performance of artistic work, and circus performances. ▪ Public events include: - dance performances - fairground amusements and parades - other events not regarded as public gatherings. Amateur sport and ▪ Young people born in 2002 or later may participate in organised sports and leisure activities, both indoors and outdoors. recreation ▪ Older age groups are encouraged to engage in sporting and leisure activities in a way that minimises risk (i.e. social distancing, outdoors, smaller groups etc.). ▪ Refrain from organising or participating in camps, matches, cups or other competitions - with the exception of professional sports or one-off competitions or matches aimed at children born in 2005 or later ▪ All unnecessary activities run by the state, regions and municipalities are urged to close, and this affects many gyms and swimming pools run by municipalities. ▪ All outdoor fitness facilities can stay open. ▪ Where open, gyms, indoor sports facilities, and swimming facilities must calculate the number of visitors so that each person is given 10m2 of space. ▪ There is a further limit of 500 visitors for sports facilities. ▪ Max 8 people at public events including sports competitions and exhibitions. Professional sport ▪ Permitted. Other Regional Restrictions ▪ The Public Health agency of Sweden may introduce stricter guidelines in the individual 18 regions.

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Table 3 Summary of current public health measures by country (extracted on 16 April 2021)

England(8) Current Level: Step 2 of Spring 2021 Roadmap Effective from and to: 12/04/2021 – At least 17/05/2021

Movement of people ▪ No restrictions on movement Social/mass gatherings Socialising ▪ No household mixing indoors. ▪ You can meet up outdoors with friends and family you do not live with, either: ▪ in a group of up to 6 from any number of households (children of all ages count towards the limit of 6) ▪ in a group of any size from up to two households (each household can include an existing support bubble, if eligible)

Places of worship Communal worship is permitted. The number allowed at any service is determined by a risk assessment on the building where it is held

Funerals ▪ Max 30 people.

Weddings ▪ Max 15 people. Business Activities Retail ▪ Non-essential retail can reopen

Food and beverage ▪ Outdoor hospitality venues can reopen, with table service only

Personal care services ▪ Personal care services such as hairdressers and nail salons can reopen, including those provided from a mobile setting

Accommodation ▪ Self-contained accommodation can stay open for overnight stays in England with your household or support bubble

Primary schools ▪ Open for face-to-face teaching Secondary schools ▪ Open for face-to-face teaching Higher and adult education ▪ Open for face-to-face teaching for practical higher education. ▪ University students undertaking practical or practice-based courses who require specialist equipment and facilities can attend face-to-face teaching and learning with regular testing now in place. All other students should continue to learn remotely. Domestic travel ▪ No restrictions on movement. (including transport) Culture/leisure/ Open entertainment Indoor: ▪ Public buildings such as libraries and community centres can reopen. ▪ Indoor leisure and sports facilities can reopen for individual exercise, or exercise with your household or support bubble. ▪ Childcare and supervised activities are allowed indoors (as well as outdoors) for all children. Parent and child groups can take place indoors (as well as outdoors) for up to 15 people (children under 5 will not be counted in this number).

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England(8) Current Level: Step 2 of Spring 2021 Roadmap Effective from and to: 12/04/2021 – At least 17/05/2021

▪ Community facilities (community centres and town and parish halls) for the purposes of: - formal education or training - support groups - registered childcare or supervised activities for children - wedding ceremonies, funerals and wakes (numerical limits must be adhered to).

▪ Indoor events or gatherings outside of someone’s household or support bubble are not permitted at Step 2 (even in a venue permitted to open) unless a specific exemption applies. This might include, for example: - for work purposes (where this cannot be done from home) - support groups - supervised activities for children and parent and child groups.

▪ Outdoor attractions that can reopen include, but are not limited to: - attractions including zoos, theme parks, and drive-in performances (such as cinemas and concerts) - some smaller outdoor events such as fetes, literary fairs, and fairgrounds can take place - Outdoor playgrounds. - Sculpture parks. - Stately or historic homes, castles or other heritage sites. - Botanical gardens. - Biomes or greenhouses. - Landmarks including observation decks and viewing platforms - film studios - funfairs and fairgrounds - model villages - museums and galleries - skating rinks - games and recreation venues, including laser quest, escape rooms, paintballing and recreational driving facilities - theme parks - trampolining parks - water and aqua parks. Amateur sport and ▪ Indoor sports and leisure facilities are also permitted to reopen for individual exercise with your household or support bubble. This includes at: recreation - gyms and leisure centres - sports courts - swimming pools - dance studios and fitness centres - driving and shooting ranges - riding arenas - archery venues - climbing wall centres.

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Table 3 Summary of current public health measures by country (extracted on 16 April 2021)

England(8) Current Level: Step 2 of Spring 2021 Roadmap Effective from and to: 12/04/2021 – At least 17/05/2021

▪ Indoor sport and exercise classes must not go ahead unless they are part of formal education or training or form a supervised activity for children.

Professional sport ▪ Elite sportspeople (or those on an official elite sports pathway) can meet in larger groups or meet indoors to compete and train. They can be joined by their coaches if necessary, or their parents and guardians if they’re under 18.

Other Step 3: not before 17 May Social contact ▪ As part of Step 3, no earlier than 17 May, the government will look to continue easing limits on seeing friends and family wherever possible, allowing people to decide on the appropriate level of risk for their circumstances. ▪ This means that most legal restrictions on meeting others outdoors will be lifted - although gatherings of over 30 people will remain illegal. ▪ Indoors, the Rule of 6 or 2 households will apply - we will keep under review whether it is safe to increase this. ▪ As soon as possible and by no later than Step 3, we will also update the advice on social distancing between friends and family, including hugging. But until this point, people should continue to keep their distance from anyone not in their household or support bubble. Business and activities ▪ Most businesses in all but the highest risk sectors will be able to reopen. ▪ In all sectors, COVID-Secure guidance will remain in place and businesses may not cater for groups bigger than the legal limits. ▪ Indoor hospitality will reopen and as in Step 2, venues will not have to serve a substantial meal with alcoholic drinks and nor will there be a curfew. ▪ Customers will, however, have to order, eat and drink while seated. ▪ Other indoor locations to open up in Step 3 include: - indoor entertainment venues such as cinemas and children’s play areas - the rest of the accommodation sector, including hotels, hostels and B&Bs - indoor adult group sports and exercise classes. ▪ The government will also allow some larger performances and sporting events in indoor venues with a capacity of 1,000 people or half-full (whichever is a lower number), and in outdoor venues with a capacity of 4,000 people or half-full (whichever is a lower number). ▪ In the largest outdoor seated venues, where crowds can be spread out, up to 10,000 people will be able to attend (or a quarter-full, whichever is lower). Events ▪ Up to 30 people will be able to attend weddings, receptions and wakes, as well as funerals. This limit will also apply to other types of significant life events including bar mitzvahs and christenings. Review of social distancing ▪ Finally, before Step 4 begins, the government will complete a review of social distancing and other long-term measures that have been put in place to cut transmission. ▪ This will inform decisions on the timing and circumstances under which the rules on 1m plus, the wearing of face coverings and other measures may be lifted. This will also inform guidance on working from home – which should continue wherever possible until this review is complete.

Step 4: not before 21 June Social contact ▪ By Step 4 which will take place no earlier than 21 June, the government hopes to be in a position to remove all legal limits on social contact. Business, activities and events ▪ We hope to reopen remaining premises, including nightclubs, and ease the restrictions on large events and performances that apply in Step 3. ▪ This will be subject to the results of a scientific Events Research Programme to test the outcome of certain pilot events through the spring and summer,

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England(8) Current Level: Step 2 of Spring 2021 Roadmap Effective from and to: 12/04/2021 – At least 17/05/2021

where we will trial the use of testing and other techniques to cut the risk of infection. ▪ The same Events Research Programme will guide decisions on whether all limits can be removed on weddings and other life events.

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Northern Ireland(53) Current Level: Stage 2 of ‘Moving Forward’ plan Effective from and to: 12/04/2021 – 23/04/2021

Movement of people ▪ Stay at home and only leave your home for essential reasons. ▪ Work from home unless unable to do so. Social/mass gatherings Household gatherings ▪ Up to 10 people (including children) from no more than two households can meet up outdoors in a private garden. ▪ One bubble can be formed with one other household. ▪ No overnight stays from your home, unless it is in the house of a member of your bubble.

Indoor Household Bubble gatherings ▪ Max 10 people from 2 households.

Outdoor gatherings ▪ Two households of any size, can meet outdoors.

Places of worship ▪ Open for acts of worship ▪ Numbers attending must be determined by a risk assessment.

Funerals ▪ The number permitted to attend funerals, is to be informed by a risk assessment for the venue. ▪ Pre and post-funeral gatherings are not permitted.

Weddings and civil partnerships ▪ The number permitted to attend weddings and civil partnerships is to be informed by a risk assessment for the venue. ▪ No receptions.

Business Activities Retail ▪ Essential retail open. ▪ Non-essential retail closed. ▪ Contactless click/ phone and collect is permitted for non-essential retail businesses. ▪ Outdoor retail, such as car washes; car, vehicle and caravan retailers; garden centres and plant nurseries is permitted to open. ▪ Car boot sales are not permitted. ▪ Homeware stores must remain closed.

Food and beverage ▪ Hospitality sector closed. ▪ Take-away services open until 11pm. ▪ Off sales closed at 8pm.

Accommodation ▪ All tourism accommodation closed.

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Table 3 Summary of current public health measures by country (extracted on 16 April 2021)

Northern Ireland(53) Current Level: Stage 2 of ‘Moving Forward’ plan Effective from and to: 12/04/2021 – 23/04/2021

Personal services Closed Primary schools ▪ Open for face-to-face teaching. Secondary schools ▪ Open for face-to-face teaching. Higher and adult education ▪ Universities and Further Education to provide learning at distance except where it is essential to provide face-to-face teaching. Domestic travel ▪ To help reduce the risk of COVID-19 spreading you should stay in your local area. (including transport) ▪ Where travel is necessary for work, education and other essential purposes, you are asked to walk, cycle or use private transport, shared only with members of your household where possible. Culture/leisure/ Open entertainment ▪ Public parks and outdoor play areas. ▪ Libraries for ‘call and collect’ services and access to the internet. ▪ Community centres with restrictions. ▪ Theatres and concert halls are permitted to open for rehearsals or a live recording without an audience.

Closed ▪ Outdoor and indoor visitor attractions. Amateur sport and ▪ Up to 10 people (including children of all ages) from a maximum of two households can take part in outdoor exercise or sports activities. recreation ▪ Up to 15 people (including coaches) can take part in structured outdoor sports training, through clubs or individuals affiliated to recognised sports governing bodies or representative organisations for sport and physical activity. ▪ Outdoor sports facilities can re-open but only to permit their use for those allowed in the regulations. ▪ Club houses and indoor sports facilities (changing rooms, showers, kitchens, meeting rooms), apart from essential toilet facilities must stay closed. ▪ Indoor sport is not permitted, other than at elite level. Professional sport ▪ Elite training and competition can continue, both indoors and outdoors. ▪ Elite sporting events must be held behind closed doors without spectators. Other ▪ The current regulations will be reviewed on 13 May 2021.

Key upcoming dates

From 23 April: • Outdoor visitor attractions and activity centres may reopen. This includes drive-in cinemas and performances. • When going to these events, you must not share your vehicle with anyone outside your household or bubble. • Close contact services (including those provided from a mobile setting) can reopen. • Driving instruction, theory tests and driving tests can also resume. • Squad training can resume, as well as competitive outdoor sports.

From 30 April: • Up to 15 people (including children) from no more than 3 households can meet up outdoors in a private garden, but you should maintain social distancing. • You can stay overnight in self-contained accommodation with your household or bubble. You must not stay overnight with anyone not in your household or bubble, unless a legal exemption applies. • Self-contained tourism accommodation may reopen. This is accommodation with no shared facilities, which can be exclusively used by a single household/

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Table 3 Summary of current public health measures by country (extracted on 16 April 2021)

Northern Ireland(53) Current Level: Stage 2 of ‘Moving Forward’ plan Effective from and to: 12/04/2021 – 23/04/2021

bubble. • Outdoor areas at hospitality venues (cafes, restaurants, bars, pubs, social clubs, including in members’ clubs) can reopen. A max of 6 people from 2 households can be seated together. Children aged 12 and under are not counted in the total and more than 6 will also be permitted if they all belong to a single household. Apart from entering and leaving the premises, the only movement allowed indoors is to access toilet facilities, to select food from a buffet or to pay - however, social distancing must be maintained. • All shops can reopen and off-licences will be permitted to sell alcohol after 8.00 pm • Gyms, swimming pools and indoor leisure facilities may open for individual exercise and also one-to-one training/ coaching with social distancing.

An indicative date of 24 May has been set for: • The mixing of households in private dwellings. • The reopening of indoor hospitality venues and all tourism accommodation. This will be subject to review. • The reopening of indoor visitor and cultural attractions. • The return of indoor group exercise and training (numbers informed by venue). • The resumption of post ceremony receptions or functions (numbers to be informed by a risk assessment for the venue). • The resumption of post-funeral gatherings (numbers to be informed by a risk assessment for the venue). Each of the above are subject to review.

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Table 3 Summary of current public health measures by country (extracted on 16 April 2021) Scotland – 5/32 local Current Level: Level 3 Effective from and to: Subject to regular review authority areas(121) Movement of people ▪ You must not travel into or out of Level 3 and 4 local authority areas. Social/mass gatherings ▪ No in-home socialising. ▪ You can meet one other household indoors in a public place. ▪ Max 6 people from up to 6 households can meet outside their home in a private garden or in a public place. ▪ Children under the age of 12 from these households do not count towards the total number of people permitted to gather indoors in a public place but do count towards the max of 2 households permitted to meet. ▪ Where an individual household includes more than 6 people, they can nevertheless meet as a single household outdoors, even if the total number of people exceeds 6. ▪ Marches, parades and static demonstrations not permitted.

Places of worship ▪ Open - max 50 people.

Funerals ▪ Max 20 people.

Weddings/civil partnership registrations ▪ Max 20 people.

Others ▪ Other life events (e.g. christenings, bar mitzvahs) can take place, with a maximum of 50 people. Business Activities Retail ▪ Open. ▪ Mobile close contact service providers must not operate in level 3 with the exception of hairdressers and barbers. ▪ Other close contacts services are permitted to open.

Food and beverage ▪ Open until 5pm. Premises closed at 6pm. ▪ No alcohol served.

Accommodation ▪ Open for work related use. ▪ Those living in a Level 3 area can still use holiday accommodation in their area but should not stay in the same self-catered accommodation with another household.

Primary schools ▪ Open for face-to-face teaching. Secondary schools ▪ Open for face-to-face teaching. Higher and adult education ▪ Colleges and universities can operate using a mix of face-to-restricted mix of face and distance learning. Domestic travel ▪ Active travel (walk, run, cycle, and wheel) where possible. (including transport) ▪ Essential use of public transport only.

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Table 3 Summary of current public health measures by country (extracted on 16 April 2021) Scotland – 5/32 local Current Level: Level 3 Effective from and to: Subject to regular review authority areas(121) ▪ Avoid car sharing with people not in your household. ▪ Travel within Scotland for outdoor socialising, recreation and exercise will be allowed from Friday 16 April. Culture/leisure/ ▪ All leisure and entertainment premises must be closed. entertainment ▪ Public buildings open. ▪ Visitor attractions open. Amateur sport and Indoors recreation ▪ Individual exercise only (exemption for under 18s). Outdoors ▪ All permitted except adult (18+) contact sports. Professional sport ▪ Permitted. ▪ Stadia must be closed to spectators. ▪ No live events are permitted. Other Should data permit, the whole of Scotland, including all island communities, will then be in Level 3 from Monday 26 April.

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Table 3 Summary of current public health measures by country (extracted on 16 April 2021) Scotland – 27/32 local Current Level: ‘Stay at Home’ (replaced Level 4) Effective from and to: Subject to regular review authority areas(46) Movement of people ▪ If you live in a Level 4 area you must not travel outside your local authority area unless for a permitted reason. ▪ Permitted reasons for travel include travel anywhere in Scotland to meet others (in groups of up to 6 adults from 6 households) socially outdoors, for recreation or exercise. Social/mass gatherings ▪ No in-home socialising. ▪ You can meet in groups of up to 6 from 6 households outdoors in your garden or a public place. ▪ The maximum number of people who can meet indoors in a public place is 4 which can be from up to 2 separate households. ▪ When meeting outdoors, children under the age of 12 do not count towards the total number of people or households counted in a gathering, but do count towards the number of households when meeting indoors – but not the number of people. ▪ Where an individual household includes more than 6 people, they can meet outside as a household even if the total number of people exceeds 6. ▪ Marches, parades and static demonstrations not permitted.

Places of worship ▪ Indoor acts of worship should be limited to a maximum of 50 people.

Funerals ▪ Max 20 people. ▪ No post funeral events.

Weddings/civil partnership registrations ▪ Max 5 people (6 if interpreter is required). No receptions allowed.

Others ▪ Other life events (e.g. christenings, bar mitzvahs) can take place, with a maximum of 50 people.

Business Activities Retail ▪ Essential retail open. ▪ Non-essential retail closed. ▪ Premise-based hairdressers and barbers are permitted to open on an appointment only basis. ▪ Click and collect services can resume for collection of goods by appointment

From 5 April 2021, the list of retailers allowed to open in Level 4 areas has been extended to include:

▪ garden centres and plant nurseries ▪ key cutting shops ▪ mobility and independent living aids shops ▪ baby equipment shops ▪ electrical goods shops, for the purposes of repair ▪ premises-based hairdressers and barbers which, by law, must be by appointment only and for a specified time ▪ homeware shops ▪ homeware showrooms. Face-to-face design consultations within showrooms should be by appointment where possible, with the size of shopping groups to be kept to a minimum.

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Food and beverage ▪ Restaurants, cafes, pubs and bars closed. ▪ Takeaways can still operate as normal, provided food and drink is sold for consumption off the premises.

Holiday accommodation ▪ All holiday accommodation closed to tourism. ▪ Hotels, B&Bs and self-catering can remain open for essential customers only. ▪ Hotels and other accommodation providers can serve food to guests staying in their premises up to 10pm. ▪ Room service, including alcohol, is allowed as normal.

Primary schools ▪ All schools are expected to re-open for full-time in-school learning following the Spring break holidays (pupils returning to school in the period 12–20 April).

▪ This means that from the 12-20 April:

- the continuation of full-time in-school learning for all primary school pupils, as from 15 March - the continuation of regulated childcare, including breakfast and after-school clubs, as from 15 March

Secondary schools ▪ All schools are expected to re-open for full-time in-school learning following the Spring break holidays (pupils returning to school in the period 12–20 April).

▪ This means that from the 12-20 April:

- an expected return to full-time in-school learning for all secondary school pupils - the continuation of regulated childcare, including breakfast and after-school clubs, as from 15 March

Higher and adult education ▪ Colleges and universities can operate using a mix of face-to-restricted mix of face and distance learning. Domestic travel ▪ Travel within Scotland for outdoor socialising, recreation and exercise will be allowed from Friday 16 April (including transport) Culture/leisure/ ▪ All indoor leisure and entertainment premises are closed. entertainment Amateur sport and ▪ Max 15 adults for outdoor non-contact sport and organised group exercise permitted. recreation ▪ Max 15 young people aged 12-17 years for outdoor non-contact sport and organised group exercise can travel across local council boundaries to take part in these activities. ▪ Organised sport and exercise for under-12s can continue in line with guidance.

Open ▪ Outdoor gyms. ▪ Golf courses. ▪ Tennis courts.

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Professional sport ▪ Permitted. ▪ Stadia must be closed to spectators. ▪ No live events are permitted. Other Advised changes to Restrictions ▪ From 26 April, both colleges and universities will operate ‘Restricted Blended Learning’ in Levels 4 and 3, and ‘Blended Learning’ in Levels 2, 1 and 0. ▪ From 26 April, it is planned that travel within Scotland, England and Wales will be allowed (subject to any local restrictions in place). ▪Travel restrictions between Scotland and the rest of the Common Travel area (Northern Ireland, the Republic of Ireland, Channel Islands and the Isle of Man) will be kept under review. ▪ Should data permit, the whole of Scotland, including all island communities, will then be in Level 3 from Monday 26 April.

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Table 3 Summary of current public health measures by country (extracted on 16 April 2021)

Wales(36) Current Level: Alert Level 4 Effective from and to: Until such time as the situation changes

Movement of people ▪ Work from home if you can.

Social/mass gatherings ▪ Do not create an extended household (single adults or single parents may join with one other household to form an exclusive support bubble). ▪ Up to 6 people from 2 households (not including children under 11 from either household or carers of a member of the household) are permitted to meet outdoors, including in private gardens and private outdoor spaces

Places of worship ▪ Open.

Crematoriums ▪ Open.

Weddings and funerals ▪ Weddings allowed in venues that are allowed to be open with ceremony limit set based on capacity of venue. No reception/social gathering permitted. ▪ Funerals allowed with ceremony limit set based on capacity of venue.

Business Activities Open ▪ All retail ▪ Self-contained accommodation ▪ Close contact services.

Closed ▪ Hospitality (except for takeaway and delivery). ▪ Licensed premises. Takeaway and delivery only between 6am and 10pm. Primary schools ▪ Open for face-to-face teaching. Secondary schools ▪ Open for face-to-face teaching. Higher and adult education ▪ Mix of in-person and remote learning. Domestic travel Public Transport (including transport) ▪ Services are continuing, particularly during peak times. ▪ However, bus and rail timetables have been reduced and potentially subject to late cancellations. Taxis ▪ Taxis can still operate where measures are in place to mitigate the risks which are involved when sharing a vehicle. ▪ However, all journeys must be for one of the very limited purposes allowed under alert level 4 restrictions. ▪ It is not recommend that you share a car with people who are not part of your household or support bubble unless it is necessary and there are no other alternatives.

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Table 3 Summary of current public health measures by country (extracted on 16 April 2021)

Wales(36) Current Level: Alert Level 4 Effective from and to: Until such time as the situation changes

Culture/leisure/ Open entertainment ▪ Community centres - limited opening (for example, for essential public services). ▪ Playgrounds. ▪ Public parks. ▪ Libraries. ▪ Some outdoor visitor attractions.

Closed ▪ Venues for events and conferences. ▪ Theatres and concert halls. ▪ Indoor and the majority of outdoor visitor attractions. ▪ Entertainment venue. ▪ Nightclubs and adult entertainment venues. Amateur sport and ▪ Outdoor exercise with household, support bubble, or with people from 1 other household, as long as the max number of people exercising is 4 (excluding recreation any carers or children under 11 from either of those households). ▪ Outdoor sport and leisure facilities, such as parks, children’s playgrounds, tennis courts, golf courses and bowling greens, can open. Facilities that are mainly outdoors but have some shelter, for example, golf driving ranges, can also open.

Closed ▪ All indoor sport and leisure facilities must close Professional sport ▪ Permitted. Other From 26 April If public health conditions permit, the following relaxations can go ahead: ▪ Outdoor hospitality can open. ▪ Organised outdoor activities will be permitted for up to 30 people. ▪ Outdoor wedding receptions will be permitted for up to 30 people. ▪ Outdoor visitor attractions can open.

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Table 3 Summary of current public health measures by country (extracted on 16 April 2021)

Israel(41) Current Level: Various Effective from and to: Various

Movement of people ▪ No restrictions. Social/mass gatherings ▪ Max 20 people indoors. ▪ Max 100 people outdoors. ▪ Max 100 people if the gathering place includes both indoor and outdoor spaces.

Houses of worship – without a Green Pass ▪ Max 20 indoors. ▪ Max 100 outdoors. Houses of worship – with a Green Pass (Subject to advanced registration with the local council) ▪ In an indoor venue with fewer than 5,000 seats – up to 50% the max permitted occupancy and no more than 1,000 people. ▪ In an indoor venue with more than 5,000 seats – up to 40% the max permitted occupancy and no more than 4,000 people. ▪ In an outdoor venue with fewer than 10,000 seats – up to 50% the max permitted occupancy and no more than 3,000 people. ▪ In an outdoor venue with more than 10,000 seats – up to 30% the max permitted occupancy and no more than 10,000 people. If there are more than 5,000 people in the venue (and up to 10,000) – they should be al be seated to prevent crowding. A distance of one empty seat between people who do not live together. Business Activities Retail The following may open with no requirement to present the Green Pass: ▪ Essential stores - Food stores, stores selling hygienic products, pharmacies, optics shops, laundromats, laboratories for repairing communication devices and computers, stores selling essential appliances and stores selling essential housekeeping products. - Max 1 person per each 7sqm up to max 20 people, whichever is higher. ▪ Commercial centres and street-facing stores - Small store (less than 300 sqm) - 1 person per each 7 sqm or max 20 people. - Large store (over 300 sqm) – 1 person per each 15 sqm. ▪ Shopping malls - In the common areas – 1 person per each 15 sqm. - Inside stores – according to store type (essential, small or large). - No eating in the shopping mall. ▪ Markets - 1 person per each 15 sqm (outdoors). - 1 person per each 15 sqm (indoors) and 300 people max. Subject to Green Pass requirements. ▪ Any business may offer delivery and take away services.

Personal services (hair salons, beauty and cosmetics parlours, tattoo parlours) ▪ 1 person per each 7 sqm or max 20 people indoors – whichever is higher. ▪ When providing bodily care, care givers must wear a mask and a face guard and sanitize the equipment.

Hospitality & Tourism The following may open: ▪ Guest units and Zimmers (B&B) up to 6 units, excluding the use of the common areas (such as pools and dining rooms)

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Table 3 Summary of current public health measures by country (extracted on 16 April 2021)

Israel(41) Current Level: Various Effective from and to: Various

- Each unit may only house a group of people living in the same house. ▪ Hotels and guest units serving as substitute residence (whether long-term or short-term) - for anyone renting them (such as foreign workers) - excluding the use of the common areas. ▪ Isolation hotels or motels for the use of patients and their families adjacent to a medical establishment.

Hospitality & Tourism - Green Pass ▪ Hotels (including guest complexes with over 6 units) – for Green Pass holders and children younger than 16 who tested negative for coronavirus up to 48 hours before arriving in the hotel - In the common areas – 1 person per each 7 sqm or max 20 people indoors and max 100 people outdoors – whichever is higher. - In the dining areas: Max 50% capacity and max 300 people, 2m distance between tables and no self-serving. - Jacuzzis (hot tubs) are only open for people who arrived together. - Saunas are closed. - Swimming pools or gyms – require 2m distance or partitions.

Restaurants The following may open: ▪ Restaurants, cafes and bars – outdoor dining - max 100 people - 2m distance between table and at least one empty seat between people who don't live together when seated at the bar.

Restaurants - Green Pass ▪ Green: Restaurants, cafes and bars – indoor dining - for Green Pass holders - Capacity 75% and max 100 people - 2m distance between table and at least one empty seat between people who don't live together when seated at the bar.

Primary schools ▪ In areas and local councils designated as green, yellow or orange according to the Traffic Light model, schools will reopen, subject to the guidance and restrictions. ▪ In programs for children aged 0-3 and preschool children in localities that belong to local councils -- the colour is set by locality, not the colour of the local council.

Group composition ▪ Where open, from 1st to 10th grades must adhere to capsule composition Classroom learning activities will be held in regular groups with regular staff members. - 1st through 4th grades – in the regular classrooms (the entire classroom is considered one regular and separate group) - 5th through 10th grades – regular groups of up to 20 pupils per class. The number of pupils may be increased to up to 24 per group – subject to the Ministry of Education's approval. - 1st through 6th grades – pupils may not alternate between groups. - 7th through 10th grades – In educational establishment that opted to participate in Magen Education program for: School activities will be held without capsule restrictions for participant age groups.

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Table 3 Summary of current public health measures by country (extracted on 16 April 2021)

Israel(41) Current Level: Various Effective from and to: Various

- In physical education classes and in practical training sessions held outdoors – groups may mingle

- Pupils in their schools' sports teams or clubs who participate in activities or matches by the Ministry of Education or by the Sports Association of Schools in Israel – groups may mingle

-Swimming lessons may be held in an indoor swimming pool, provided that the pool is only used for swimming lessons for children during those hours.

Afterschool programs for preschool children and 1st through 4th graders ▪ Activity permitted in areas and local councils designated as green, yellow or orange

▪ Schools in red-designated localities closed for face-to-face teaching and will operate by distance learning.

Secondary schools ▪ In areas and local councils designated as green, yellow or orange according to the Traffic Light model, schools will reopen, subject to the guidance and restrictions.

▪ Schools in red-designated localities closed for face-to-face teaching and will operate by distance learning, unless at least 75% of all 11th and 12th grade pupils are either vaccinated or recovered - i.e. Green Pass holders

Group composition ▪ Where open, from 11th to 12th grades, school activities will be held in regular groups with regular staff members - In regular groups of up to 20 pupils per class. This number may be increased to up to 24 pupils upon the Ministry of Education's approval. - In educational establishments where at least 65% of all 11th or 12th grade pupils are Green Pass holders – school activities will be held without capsule restriction for participant age groups.

Boarding schools ▪ Boarding schools may reopen only if all students live in the boarding school (all levels). ▪ Closed track boarding schools - Boarding schools where all pupils and staff members reside on site for a period of two weeks at least and there are no external pupils may operate under the guidelines for closed programs. - Groups of up to 50 participants, no mingling. - Groups of 50 participants who have remained inside the boarding school premises for an additional 30 day period (beyond the 14 day period) are permitted to mingle, if no confirmed patients have been detected in them. - Other staff members may enter the boarding school if they maintain complete separation from the pupils and staff members in the closed programs -There is an option to send the pupils home for 14 days and subsequently reassemble them.

Open track -In regular groups of up to 18 participants, with complete separation between groups -No restrictions on entering or leaving the boarding school premises. -Activities subject to the Green Pass outline may be held in:

- Secondary boarding schools – for the 11th and 12th grades where at least 90% of all pupils are Green Pass holders.

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Table 3 Summary of current public health measures by country (extracted on 16 April 2021)

Israel(41) Current Level: Various Effective from and to: Various

- Post-secondary boarding schools where at least 90% of all pupils are Green Pass holders in which 90% of all pupils are Green Pass holders, No restrictions on entering or leaving the boarding school premises, In regular groups of up to 500 pupils.

Higher and adult education Technical colleges (13th and 14th grades) ▪ Classroom learning resumed in areas and local councils designated as green, yellow or orange, with regular groups of up to 50 students and staff. ▪ In red designated localities, classroom learning activities will only be held for at risk youth.

Adult practical training ▪ Activities resumed in all settings (groups of up to 20 participants) (all levels).

Establishments of higher learning, practical training and religious education ▪ To be held soon for students with a Green Pass only (all levels). - In an indoor venue with fewer than 5,000 seats – up to 75% of the maximum permitted occupancy and no more than 1,000 people. -In an indoor venue with more than 5,000 seats – up to 40% the maximum permitted occupancy and no more than 4,000 people. Seated activities only, no eating during activities. - Distance learning options will be ensured for students who do not have a Green Pass. -Social activities and ceremonies may be held.

▪ Outdoor activities are permitted for learners of all ages. Domestic travel ▪ Public transportation operating at 75% capacity. (including transport) Culture/leisure/ The following may open: entertainment ▪ Museums - Small museum (fewer than 3000 sqm) – 1 person per each 7 sqm or max 20 people, whichever is higher. - Large museum (over 3000 sqm) – 1 person per each 15 sqm. - Tickets should be purchased in advance. - Guided tours max 20 people, subject to advanced reservation. ▪ Nature reserves, national parks, national heritage sites and monuments - 1 person per each 15 sqm or max 100 people, whichever is higher. - Outdoor activities only. - Excluding the use of facilities. ▪ Exhibitions (not in museums) - Occupancy: At a ratio of one person per each 7 square meters and up to 300 people. - Guided tours: 20 people max, in advance booking. ▪ Zoos and safaris - 1 person per each 15 sqm or max 100 people, whichever is higher. - Outdoor activities only. - Excluding the use of facilities. ▪ Tourist Attractions – indoor (e.g. ice rink, bowling) – for Green Pass holders. - Except for attractions whose opening for non-Green Pass holders was approved by the Ministry of Health's Director General.

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Table 3 Summary of current public health measures by country (extracted on 16 April 2021)

Israel(41) Current Level: Various Effective from and to: Various

▪ Tourist attractions – no Green Pass required - Outdoor attractions (e.g. water parks, kayaking, petting zoos)

- 1 person per each 15 sqm, or up to 100 people -whichever is higher, for attractions without facilities. - In outdoor attractions which includes facilities: - 1 person per each 15 sqm, or up to 100 people -whichever is higher. In addition, - In a venue where the maximum permitted occupancy is fewer than 10,000 seats – no more than 1500 people. - In a venue where the maximum permitted capacity is more than 10,000 seats – no more than 2,500 people. - Only people living together may stay together in each activity unit (compartment, car, boat, kayak, float etc.) in the attraction. ▪ Libraries - 1 person per each 7 sqm or max 20 people indoors – whichever is higher. ▪ Guided Tours. - Subject to advanced reservation. - Outdoor activities only.

Green Pass Cultural events, conferences and ceremonies, recreational programs for adults, parties, event venues and gardens, theatreand cinemas may be held according to the Green Pass requirements in one of two possible outlines: 1) Seated attendance without serving food ▪ Occupancy: - In an indoor venue with fewer than 5,000 seats – up to 50% the maximum permitted occupancy and no more than 1,000 people. - In an indoor venue with more than 5,000 seats – up to 30% the maximum permitted occupancy and no more than 3,000 people. - In an outdoor venue with fewer than 10,000 seats – up to 50% the maximum permitted occupancy and no more than 3,000 people. - In an outdoor venue with more than 10,000 seats – up to 30% the maximum permitted occupancy and no more than 5,000 people. - In the gathering areas: At a ratio of one person per each 7 square meters. - Tickets should be purchased in advance. - Marked seats, separation of one empty seat between groups of people. Those who bought tickets together may be seated together. - Seated spectating with no breaks (so far as possible) and no dancing. - No eating or drinking in place. - Gradual entry and exit to and from the venue. - A ratio of 1:75 between ushers and attendees for enforcing the Green Pass requirements. - Signs and sanitation – in accordance with the regulations.

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Table 3 Summary of current public health measures by country (extracted on 16 April 2021)

Israel(41) Current Level: Various Effective from and to: Various

- Food may be served or sold. - A ratio of 1:75 between ushers and attendees for enforcing the Green Pass requirements. - Separation will be maintained between the areas used for eating and the other areas. - Signs and sanitation – in accordance with the regulations. ▪ Green: tourist attractions for Green Pass holders - 1 person per every 7 sqm or according to restrictions on capacity (max 20 people indoors and max 50 people outdoors), whichever is higher. - Only people living together may stay together in each activity unit (compartment, car, boat, kayak, float etc.) in the attraction.

Amateur sport and The following may be opened and operated, regardless of Green Pass status: recreation ▪ Dancing studios for competitive dancers younger than 16 ▪ Swimming pools - outdoors - 1 person per each 15 square meters or up to 100 people – whichever is higher. - Within the water – 1 person per each 6 square meters. - Subject to advanced reservation. - No sitting in the concession stand area. - Jacuzzis are only open for people who arrived together.

Green Pass ▪ Gyms and studios – for Green Pass holders - 1 person per 7 sqm or max 20 people indoors and max 100 people outdoors – whichever is higher. - Early booking. - Partitions or a 2m distance between every two stations and every two patrons. - Jacuzzis are only open for people who arrived together. - Saunas are closed. ▪ Swimming Pools (indoors)– for Green Pass holder - 1 person per 7 sqm or max 29 people indoors and max 50 people outdoors – whichever is higher. - Inside the water – 1 person per each 6 sqm. - Early booking. - No seating in the concession stand area. - Jacuzzis are only open for people who arrived together. - Saunas are closed.

▪ Sport facilities and popular sport games – whether indoors or outdoors - 1 person per 7 sqm or max 20 people indoors and max 100 people outdoors – whichever is higher.

▪ Amateur sporting events with mass participation (delimited sport tournament that includes running, walking, swimming, biking and so on) - Subject to the participants' advanced registration - Up to 1,000 participants per event

Sporting events may be held according to the Green Pass requirements in one of two possible outlines: 1) Seated attendance without serving food

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Table 3 Summary of current public health measures by country (extracted on 16 April 2021)

Israel(41) Current Level: Various Effective from and to: Various

▪ Occupancy: - In an indoor venue with fewer than 5,000 seats – up to 50% the maximum permitted occupancy and no more than 1,000 people. - In an indoor venue with more than 5,000 seats – up to 30% the maximum permitted occupancy and no more than 3,000 people. - In an outdoor venue with fewer than 10,000 seats – up to 50% the maximum permitted occupancy and no more than 3,000 people. - In an outdoor venue with more than 10,000 seats – up to 30% the maximum permitted occupancy and no more than 5,000 people. - In the gathering areas: At a ratio of one person per each 7 square meters. - Tickets should be purchased in advance. - Marked seats, separation of one empty seat between groups of people. Those who bought tickets together may be seated together. - Seated spectating with no breaks (so far as possible) and no dancing. - No eating or drinking in place. - Gradual entry and exit to and from the venue. - A ratio of 1:75 between ushers and attendees for enforcing the Green Pass requirements. - Signs and sanitation – in accordance with the regulations.

2) Seated attendance with serving food OR non-seated attendance (such as standing, walking, dancing), with or without serving food ▪ In event venues and gardens: Up to 5% of all attendees may be admitted upon presenting negative test results to a coronavirus test taken up to 48 hours prior to the event. During Passover: Up to 72 hours prior to the event. ▪ Occupancy - Indoor venue – up to 50% the maximum permitted occupancy and no more than 300 people. - Outdoor venue - up to 50% the maximum permitted occupancy and no more than 500 people - In events held in a venue with both indoor and outdoor areas – no more than 500 people in total. - In the gathering areas: At a ratio of one person per each 7 square meters. - Food may be served or sold. - A ratio of 1:75 between ushers and attendees for enforcing the Green Pass requirements. - Separation will be maintained between the areas used for eating and the other areas. - Signs and sanitation – in accordance with the regulations. ▪ Green: tourist attractions for Green Pass holders - 1 person per every 7 sqm or according to restrictions on capacity (max 20 people indoors and max 50 people outdoors), whichever is higher. - Only people living together may stay together in each activity unit (compartment, car, boat, kayak, float etc.) in the attraction.

School related sports/activities ▪ Where open (green, yellow or orange areas), for 1st to 12th grade school children: - Physical education classes and practical training sessions held outdoors – groups may mingle - Pupils in their schools' sports teams or clubs who participate in activities or matches by the Ministry of Education or by the Sports Association of Schools in Israel – groups may mingle - Swimming lessons may be held in an indoor swimming pool, provided that the pool is only used for swimming lessons for children during those hours.

Recreational programs for children and youth organisations ▪ Activity permitted in local councils designated as green, yellow or orange areas, max 50 participants ▪ Not permitted in red designated localities

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Table 3 Summary of current public health measures by country (extracted on 16 April 2021)

Israel(41) Current Level: Various Effective from and to: Various

Professional sport ▪ Indoor facilities used for training or matches of professional or competitive athletes are open (1 person per 7 sqm or up to 20 people - whichever is higher) for: - Minor athletes. - Adult athletes in the water sports. - Adult athletes who are Green Pass holders. - Professional athletes - Adult athletes who specialize in water sports.

▪ Outdoor training facilities can be used for the training of professional or competitive athletes who are registered with a sport association or union (1 person per 7 sqm or up to 100 people - whichever is higher).

▪ Senior league soccer and basketball matches can occur.

▪ Indoor swimming pools may be opened for competitive and professional athletes who are not Green Pass holders during separate hours Other Green Pass system ▪ The following can be admitted into establishments that comply with Green Pass restrictions: - Vaccinated individuals – any individual who received 2 doses and at least a week has passed since the administration of the second dose (people with a vaccination certificate) - Recovered individuals – people with a certificate of recovery who were confirmed coronavirus patients or who people who have a positive serological test result - Tested – Those who took a rapid coronavirus test at the entrance, if a rapid testing station has been placed in accordance with the list of sampling providers, and tested negative to coronavirus - Infants under one year old. - Hotels: At this time, children younger than 16 years old who are not recovered patients will not be allowed to enter. - Event halls and gardens – There are certain exceptions for event venues and gardens which allow for up to 5% of all participants to be admitted upon presenting negative test results for a regular coronavirus test (swab test). The same exceptions apply to children younger than 16 years old who wish to be admitted to hotels.

Plans for reopening: ▪ Schools will reopen for all age groups with no capsule formation, effective 18.4.2021. There will be no restrictions upon teachers and teacher assistants' ability to move between classes and schools. ▪ Third level institutions will soon resume in-person learning for those with a Green Pass (no date) ▪ Max permitted occupancy in outdoor mega-stadiums will increase from 5,000 to 10,000 people; Indoor stadiums – occupancy increased to up to 40% and up to 4,000 people max (date unknown). ▪ Maximum permitted occupancy in outdoor non-seated events and/or events where food is served increased from 500 to 750 people (date unknown).

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Private events and gatherings: ▪ Events that gather people from different municipalities should be postponed or cancelled. ▪ A max of 10 participants at private indoor events, unless this is in a private home, for example a birthday celebration in a rented venue. A max of 20 participants outdoors. ▪ Children in the same kindergarten or primary school cohort can gather, with the necessary number of adults accompanying them. ▪ A max of 10 people at indoor events without designated seating, albeit up to 50 people at sports or cultural events for participants under the age of 20 who live in the same municipality (50 people for cultural events is new).

▪ A maxi of 100 people at events where all of the participants sit in designated seating. ▪ A max of 200 people at outdoor events, but 600 people (divided into three cohorts of 200 people each) if they sit in designated seating and there is a 2m distance between each cohort. ▪ The organiser must implement measures to satisfy the distance requirements regarding participants from different households at events where participants sit in designated seating. If necessary, guards must be used to ensure this. ▪The same rules regarding serving of alcohol at events as at venues that serve food or alcohol.

▪ Children in kindergartens and primary school may receive a visit from other children in their cohort. ▪ In addition to visits from other children from their kindergarten or primary school cohort, children and adolescents may receive a visit from one or two regular friends or go visit these regular friends. Business Activities Not reported Primary schools ▪ Kindergartens and schools are at yellow level, in accordance with the traffic light model ▪ Local assessments must be made in line with the infection situation Secondary schools ▪ Kindergartens and schools are at yellow level, in accordance with the traffic light model ▪ Local assessments must be made in line with the infection situation Higher and adult education ▪ It is possible to be on campus, with enhanced infection control measures. Access to reading rooms and libraries. Large lectures and gatherings should be avoided; teaching in small groups is allowed. Domestic travel ▪ Avoid unnecessary domestic travel. This is particularly important to and from areas with a high rate of infection. (including transport) ▪ People may travel to a cabin (owned or rented) or hotel within the country, but must avoid public transportation when possible. ▪ Travel to a person's place of work or study can be considered a necessary trip. ▪ People who travel to municipalities with measures that are less strict should follow the recommendations that apply in the municipality in which they reside

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Cultural events ▪ A max of 50 people under the age of 20 who live in the same municipality at an indoors event without designated seating, otherwise a maximum of 10 people. ▪ A max of 100 people at events where all of the participants sit in designated seating. ▪ A max of 200 people at outdoor events, but 600 people (divided into three cohorts of 200 people each) if they sit in designated seating and there is a 2m distance between each cohort. ▪ The organiser must implement measures to satisfy the distance requirements regarding participants from different households at events where participants sit in designated seating. If necessary, guards must be used to ensure this. ▪ The same rules regarding serving of alcohol at events as at venues that serve food or alcohol. Amateur sport and ▪ Children and adolescents under the age of 20 may train and participate in leisure events as usual. They are exempt from the recommendation of a 1m recreation distance when this is necessary in order to participate in the activity. ▪ If children and adolescents train/practice with a team, club etc. in another municipality, they may compete with this team/club if so permitted by the infection situation. ▪ Children and adolescents under the age of 20 who participate in sports that do not involve close contact, like skiing, may participate in outdoor sports events that gather participants from the same region. ▪ Adults may participate in organised indoor activities in groups of up to 10 people, as long as they can keep a distance of at least 1 metre. ▪ Adults may participate in organised outdoor activities, as long as they can keep a distance of at least 1 metre

Sporting events ▪ A maximum of 50 people under the age of 20 who live in the same municipality at an indoors event without designated seating, otherwise a maximum of 10 people. ▪ A maximum of 100 people at events where all of the participants sit in designated seating. ▪ A max of 200 people at outdoor events, but 600 people (divided into three cohorts of 200 people each) if they sit in designated seating and there is a 2m distance between each cohort. ▪ The organiser must implement measures to satisfy the distance requirements regarding participants from different households at events where participants sit in designated seating. If necessary, guards must be used to ensure this. ▪ The same rules regarding serving of alcohol at events as at venues that serve food or alcohol. Professional sport ▪ Elite athletes may train normally, both outdoors and indoors. ▪ Outdoor practice matches in the top two levels of the Norwegian football league for women and men are allowed. The practice matches must involve as little geographical mobility as possible and are contingent on compliance with the infection control protocol of the Football Association of Norway. ▪ Practice matches are also allowed in the top two levels of the football league for women and men in municipalities with regional measures at levels A and

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Table 3 Summary of current public health measures by country (extracted on 16 April 2021) Norway (All parts of Norway except parts of Eastern Norway with regional measures imposed by the Current Level: National measures government or Effective from and to: 16/04/2021 - Various municipalities with strict local regulations, such as Oslo and Steinkjer)(37) B. In these municipalities, only players, support apparatuses and referees may attend matches. ▪ In municipalities with regional measures at level A, organised training for elite athletes will also be permitted. Other The easing of these National Measures will not affect the parts of Eastern Norway with regional measures imposed by the government or municipalities with strict local regulations, such as Oslo and Steinkje. The government can decide which measures are to be implemented in a municipality and surrounding municipalities in the event of an outbreak of infection. It will always be the most stringent measures introduced (local, regional, national) in an area that applies. ▪ Certain local municipalities may apply more stringent measures to the Government recommended ones (e.g. Oslo).

First step of easing occurred on 16 April. ▪ Further easing of restrictions will be guided by the data (e.g. The rate of infection and the disease burden, the capacity of the health services and the status of the vaccination programme) and not dates. ▪ In general, three weeks will need to elapse between each step.

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Table 3 Summary of current public health measures by country (extracted on 16 April 2021) Norway (Regions of Asker, Bærum, Drammen, Eidsvoll, Enebakk, Fredrikstad, Gjerdrum, Lier, Lillestrøm,

Social/mass gatherings ▪ All events outside the home are prohibited, including places of worship, both indoors and outdoors, with the exception of funerals, weddings and baptisms.

Places of worship ▪ Closed, except for weddings, funerals and baptisms.

Funeral ▪ Max 30 people

Weddings ▪ The couple, the officiator and 2 witnesses only

Baptisms ▪ The infant, the parents, the priest and 2 sponsors only.

Digital events ▪ Max 5 people, in addition to performers and other necessary production personnel Business Activities Retail: ▪ All shops and warehouses must be closed, with these exceptions:

- Grocery stores, including kiosks, health food and others that mainly sell groceries. - Outlets that mainly sell pet food and other necessities for pets and pets - Drugstore - Bandages - Opticians - off-licenses - One-on-one services such as hairdresser, dermatologist, tattoo artist, etc. - Health care companies, such as physiotherapists, chiropractors, podiatrists, etc. - Gas stations - Flower shops with a permanent point of sale registered in the Central Coordinating Register for Legal Entities as florists with flowers and plants, a sales area not exceeding 250 sqm. - Sales activities for agriculture and animal production - The warehouse and wholesale part in hardware stores that sell to handicrafts and the like.

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Table 3 Summary of current public health measures by country (extracted on 16 April 2021) Norway (Regions of Asker, Bærum, Drammen, Eidsvoll, Enebakk, Fredrikstad, Gjerdrum, Lier, Lillestrøm,

▪ Shops and department stores can stay open for collection of prepaid ordered goods when infection control-sound solutions have been established for delivery of the goods.

Restaurants, cafes, bars and hotels ▪ Restaurants closed, but take away is allowed. ▪ Alcohol cannot be sold. ▪ Restaurants in hotels can serve food to overnight guests

Personal services (e.g. hairdressers) ▪ Permitted, but should introduce reinforced measures such as the use of face masks in situations where it is not possible to maintain a distance of 1 meter or to reduce or temporarily remove treatment options that involve close face-to-face contact. Primary schools ▪ Kindergartens and schools are at yellow level, in accordance with the traffic light model ▪ Local assessments must be made in line with the infection situation Secondary schools ▪ Kindergartens and schools are at yellow level, in accordance with the traffic light model ▪ Local assessments must be made in line with the infection situation Higher and adult education ▪ Premises are closed to all students and remote learning is in place with exceptions if access is essential for experiments etc. Domestic travel ▪ Everyone should avoid travel that is not necessary. Travel to work must be considered necessary. (including transport) ▪ Residents in the municipality are not recommended to go to open shopping centres or department stores in neighbouring municipalities. ▪ Residents in the municipality can go to holiday homes, but only with people in their own household, and must avoid local shops. Restaurants or meeting places. ▪ Max 50% capacity on public transport. Culture/leisure/ ▪ It is not allowed to organize leisure activities for adults and young people entertainment Exceptions ▪ Outdoor organized leisure activities for children and young people under the age of 20 (max 10 people and all from same municipality) are permitted ▪ Outdoor leisure activities for persons with substance abuse problems or serious mental illness (max 5 people and all from same municipality) are permitted.

The following businesses and locations will be closed

▪ Libraries. ▪ Amusement parks, bingo halls, gaming halls, playgrounds, bowling alleys and similar places. ▪ Museums. ▪ Cinema, theatre, concert venues and similar cultural and entertainment venues. ▪ Other public places and businesses where cultural, entertainment or leisure activities take place that gather people indoors.

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Table 3 Summary of current public health measures by country (extracted on 16 April 2021) Norway (Regions of Asker, Bærum, Drammen, Eidsvoll, Enebakk, Fredrikstad, Gjerdrum, Lier, Lillestrøm,

Lørenskog, Moss, Current Level: Level A (particularly high level of measures) Effective from and to: 16/04/2021 - Various Nannestad, Nes, Nordre Follo, Rakkestad, Rælingen, Råde, Sarpsborg, Ullensaker and Ås)(37) Amateur sport and ▪ It is not allowed to organize sports activities for adults and young people recreation Exceptions ▪ Outdoor organized sports activities for children and young people under the age of 20 (max 10 people and all from same municipality) are permitted ▪ Outdoor sports activities for persons with substance abuse problems or serious mental illness (max 5 people and all from same municipality) are permitted.

The following businesses and locations will be closed

▪ Gyms. ▪ Swimming pools, water park, spa facilities, hotel pool and the like. ▪ Other public places and businesses where cultural, entertainment or leisure activities take place that gather people indoors. Professional sport ▪ Not reported Other ▪ It will always be the most stringent measures introduced (local, regional, and national) in an area that applies. If the regional measures are stricter than the national measures, then the regional measures apply.

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Table 3 Summary of current public health measures by country (extracted on 16 April 2021) Norway (Regions of Aurskog-Høland, Frogn, Halden, Hole, Hurdal, Hvaler, Indre Østfold, Jevnaker, Kongsberg, Lunner, Marker, Modum,

Nesodden, Nittedal, Current Level: Level B (High level of measures) Effective from and to: 16/04/2021 - Various Ringerike, Skiptvet, Vestby,

Våler and Øvre Eiker, Færder, Holmestrand, Horten, Larvik, Sandefjord and Tønsberg, Bamble, Porsgrunn, Siljan and Skien)(37) Movement of people ▪ Mandate for home office for all who can.

Social/mass gatherings ▪ Max of 5 visitors in a house. It is encouraged to meet outdoors. ▪ The number of contacts during a week should not exceed 10 people in addition to necessary contacts in a work context, household members and kindergarten and school cohorts. ▪ All events outside the home are prohibited, including places of worship, both indoors and outdoors, with the exception of religious gatherings, funerals, weddings, confirmations and baptisms.

Places of worship (including weddings confirmations and baptisms) ▪ Max 20 people (with fixed assigned seats)

Funeral ▪ In line with national rules on numbers (which is currently max of 100 indoors, if compliant with guidelines)

Digital events ▪ Max 5 people, in addition to performers and other necessary production personnel Business Activities Retail: ▪ Shops can stay open

Personal services: ▪ Can stay open

Restaurants, cafes, bars and hotels ▪ Open ▪ Alcohol cannot be sold Primary schools ▪ Kindergartens and schools are at yellow level, in accordance with the traffic light model ▪ Local assessments must be made in line with the infection situation Secondary schools ▪ Kindergartens and schools are at yellow level, in accordance with the traffic light model ▪ Local assessments must be made in line with the infection situation. ▪ Premises at schools approved in accordance with the Free School Act, shall not be closed to pupils.

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Nesodden, Nittedal, Current Level: Level B (High level of measures) Effective from and to: 16/04/2021 - Various Ringerike, Skiptvet, Vestby,

Våler and Øvre Eiker, Færder, Holmestrand, Horten, Larvik, Sandefjord and Tønsberg, Bamble, Porsgrunn, Siljan and Skien)(37) ▪ Schools with boarding schools must follow rules and recommendations for folk high schools, while schools without boarding schools follow rules and recommendations for upper secondary education Higher and adult education ▪ Premises are closed to all students and remote learning is in place, with exceptions if access is essential for experiments etc. Domestic travel ▪ Everyone should avoid travel that is not necessary. Travel to work must be considered necessary. (including transport) ▪ Residents in the municipality are not recommended to go to department stores in neighbouring municipalities. ▪ Residents in the municipality can go to holiday homes, but only with people in their own household, and must avoid local shops. restaurants or meeting places. ▪ Max 50% capacity on public transport Culture/leisure/ ▪ Cultural and leisure activities can be open to children and young people under the age of 20. entertainment ▪ It is not allowed to organize indoor leisure activities for people who are 20 years or older.

The following businesses and locations will be closed ▪ Swimming pools, water parks, spa facilities, hotel pools, etc. are closed, however, so that the following offers can remain open: - school swimming, organized swimming courses and organized swimming training for people under the age of 20 and swimming for top athletes. - rehabilitation and training offered individually or in small groups with an organizer. - other individual treatment for which an appointment can be booked and where the bathroom is part of the treatment. ▪ Amusement parks, bingo halls, gaming halls, playgrounds, bowling alleys and similar places. Museums. ▪ Cinema, theatre, concert venues and similar cultural and entertainment venues. ▪ Other public places and businesses where cultural, entertainment or leisure activities take place that gather people indoors. ▪ Public places and businesses where organized cultural, sports and leisure activities take place can be open for children and young people under the age of 20, outdoor activities for adults and organized indoor and outdoor training for top athletes, however, so that there are no leisure activities for others at such places.

Amateur sport and ▪ Sports activities can be open to children and young people under the age of 20. recreation ▪ It is not allowed to organize indoor sports activities for people who are 20 years or older. ▪ Swimming pools, water parks, spa facilities, hotel pools and the like are open for school swimming, organized swimming courses and organized swimming training for those under 20 and swimming for top athletes, and for rehabilitation, training and individual treatment.

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Nesodden, Nittedal, Current Level: Level B (High level of measures) Effective from and to: 16/04/2021 - Various Ringerike, Skiptvet, Vestby,

Våler and Øvre Eiker, Færder, Holmestrand, Horten, Larvik, Sandefjord and Tønsberg, Bamble, Porsgrunn, Siljan and Skien)(37) The following businesses and locations will be closed

▪ Gyms, however, so that the following offers can stay open: - rehabilitation and training offered individually or in small groups with an organizer. - individual training and treatment for which an appointment can be booked. ▪ Swimming pools, water parks, spa facilities, hotel pools, etc. are closed, however, so that the following offers can remain open: - school swimming, organized swimming courses and organized swimming training for people under the age of 20 and swimming for top athletes. - rehabilitation and training offered individually or in small groups with an organizer. - other individual treatment for which an appointment can be booked and where the bathroom is part of the treatment. ▪ Amusement parks, bingo halls, gaming halls, playgrounds, bowling alleys and similar places. Museums. ▪ Cinema, theatre, concert venues and similar cultural and entertainment venues. ▪ Other public places and businesses where cultural, entertainment or leisure activities take place that gather people indoors. ▪ Public places and businesses where organized cultural, sports and leisure activities take place can be open for children and young people under the age of 20, outdoor activities for adults and organized indoor and outdoor training for top athletes, however, so that there are no leisure activities for others at such places. Professional sport ▪ Indoor organized training for top athletes is still allowed. Other ▪ It will always be the most stringent measures introduced (local, regional, and national) in an area that applies. If the regional measures are stricter than the national measures, then the regional measures apply.

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143. Government Office for Science (UK), Scientific Advisory Group for Emergencies. The R number and growth rate in the UK. 2020. Available from: https://www.gov.uk/guidance/the-r-number-in-the-uk]. 144. Department of health and Social Care (UK). Local restriction tiers: what you need to know 2020. Available from: https://www.gov.uk/guidance/local-restriction-tiers- what-you-need-to-know#why-the-government-is-introducing-tiers 145. Department of Health (Northern Ireland). R number – Covid-19. 2020. Available from: https://www.health-ni.gov.uk/news/r-number-covid-19. 146. Scottish Government. Coronavirus (COVID-19): Scotland's Strategic Framework 2020. Available from: https://www.webarchive.org.uk/wayback/archive/20201023135508/https://www.gov .scot/publications/covid-19-scotlands-strategic-framework/. 147. Welsh Goverment. Current restrictions 2021. Available from: https://gov.wales/current-restrictions. 148. Ministry of Health (Israel). Government has Approved the Extension of the Current Restrictions and the Extensive Reopening of the Education System 2021. Available from: https://www.gov.il/en/departments/news/13042021-01. 149. Federal Ministry of Education SaRA. First assessment of the self-tests in schools 2021. Available from: https://www.bmbwf.gv.at/Ministerium/Presse/20210211.html. 150. Federal Ministry for Social Affairs Health Care and Consumer Protection (Austria). FAQ: Population-wide tests. 2020. 151. Sciensano (Belgium). Coronavirus: Testing indications and appropiate tests 2021. Available from: https://covid-19.sciensano.be/nl/procedures/indicaties. 152. Sciensano (Belgium). Testing strategy update august 2020: pooling, saliva testing, rt-lamp, rapid antigen testing, self-collected nose, throat and nasopharyngeal swabs and multiplex 2020. Available from: https://covid-19.sciensano.be/nl/covid-19- procedureshttp://covid- 19.sciensano.be/sites/default/files/Covid19/20200819_Advice_RAG_tests%20and%2 0sampling.pdf. 153. Ministry of the Interior (Czechia). Testing pupils in schools 2021. Available from: https://covid.gov.cz/opatreni/testovani-na-koronavirus/testovani-zaku-ve-skolach. 154. Ministry of Health (Denmark). When to test and which test can you use? 2020. Available from: https://www.sst.dk/da/Nyheder/2020/Hvornaar-skal-man-testes-og- hvilken-test-kan-man-bruge. 155. Ministry of Health (Denmark). Recommendations for using antigen test 2021. Available from: https://www.sst.dk/da/Udgivelser/2020/Anbefalinger-vedroerende- anvendelse-af-antigentest. 156. ORS Île-de-France (France). Covid-19, tests and screening strategies 2021. Available from: https://www.ors-idf.org/nos-travaux/publications/le-depistage-de-la-covid-19- en-ile-de-france-en-2020/. 157. Ministry of Solidarity and Health (France). RT-PCR, antigenic and salivary tests 2021. Available from: https://solidarites-sante.gouv.fr/soins-et- maladies/maladies/maladies-infectieuses/coronavirus/tout-savoir-sur-la-covid- 19/article/le-depistage. 158. l'Assurance Maladie (France). Everything you need to know about antigenic testing for SARS-CoV-2 2021. Available from: https://www.ameli.fr/assure/covid-19/tester- alerter-proteger-comprendre-la-strategie-pour-stopper-lepidemie/les-tests-de- depistage-de-la-covid-19/tout-ce-quil-faut-savoir-sur-les-tests-antigeniques-du-sras- cov-2. 159. Robert Koch Institut (Germany). National Test Strategy - who is tested for a SARS- CoV-2 infection in Germany? (in German) 2021. Available from:

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https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Teststrategie/Nat- Teststrat.html. 160. Federal Ministry of Health (Germany). More and targeted COVID-19 testing 2021. Available from: https://www.zusammengegencorona.de/en/en/more-and-targeted- covid-19-testing/. 161. Federal Ministry of Health (Germany). Information on testing 2021. Available from: https://www.zusammengegencorona.de/en/inform/information-on-testing/. 162. Health Service Executive (Ireland). Antigen testing for COVID-19 2021. Available from: https://www2.hse.ie/conditions/coronavirus/testing/antigen-testing-for-covid- 19.html. 163. Fingal County Council (Ireland). Symptom Free Walk-in COVID-19 Testing Centre Opening in Mulhuddart 2021. Available from: https://www.fingal.ie/news/symptom- free-walk-covid-19-testing-centre-opening-mulhuddart. 164. Administration of the Province of Bolzano (Italy). Rapid tests in South Tyrol: Phase 2 follows 2020. Available from: http://www.provincia.bz.it/sicurezza-protezione- civile/protezione-civile/coronavirus-test-alto-adige.asp. 165. The Minister of Education CaSTN. Use of self-tests in higher education 2021. Available from: https://www.rijksoverheid.nl/documenten/kamerstukken/2021/04/14/kamerbrief- inzake-de-inzet-van-zelftesten-in-het-hoger-onderwijs. 166. Ministry of Health WaSTN. Q & As on self-testing in higher education 2021. Available from: https://www.rijksoverheid.nl/onderwerpen/coronavirus-covid- 19/documenten/publicaties/2021/04/01/vragen-en-antwoorden-zelftesten-in-hoger- onderwijs. 167. Directorate General for Health (Portugal). COVID-19 National Testing Strategy for SARS-CoV-2 2020. Available from: https://covid19.min-saude.pt/wp- content/uploads/2020/11/Norma_019_2020_act_06_11_2020.pdf. 168. Ministry of Health (Portugal). Covid-19: National Testing Strategy 2021. Available from: https://www.sns.gov.pt/noticias/2021/02/12/covid-19-estrategia-nacional-de- testes/. 169. Instituto de Salud Carlos III (Spain). Strategy for early detection, surveillance and COVID-19 control (update) 2021. Available from: https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/alertasActual/nCov/doc umentos/COVID19_Estrategia_vigilancia_y_control_e_indicadores.pdf. 170. Ministry of Health (Spain). COVID-19 Early detection, surveillance and control strategy 2020. Available from: https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/alertasActual/nCov/doc umentos/COVID19_Estrategia_vigilancia_y_control_e_indicadores.pdf. 171. The Public Health Authority (Sweden). Sampling for COVID-19 in municipal care and care for the elderly 2021. Available from: https://www.folkhalsomyndigheten.se/publicerat- material/publikationsarkiv/p/provtagning-for-covid-19-inom-kommunal-vard-och- omsorg-for-aldre/. 172. The Public Health Authority (Sweden). Guidance for the use of antigen tests in COVID-19 2020. Available from: https://www.folkhalsomyndigheten.se/publicerat- material/publikationsarkiv/v/vagledning-for-anvandning-av-antigentester-vid-covid- 19/. 173. Public Health Agency (Sweden). Testing for covid-19 2021. Available from: https://www.folkhalsomyndigheten.se/smittskydd-beredskap/utbrott/aktuella- utbrott/covid-19/testning-och-smittsparning/. 174. Department of Health and Social Care (England). Households and bubbles of pupils, students and staff of schools, nurseries and colleges: get rapid lateral flow tests

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2021. Available from: https://www.gov.uk/guidance/rapid-lateral-flow-testing-for- households-and-bubbles-of-school-pupils-and-staff. 175. Department of Health and Social Care (England). Testing for coronavirus before hospital 2021. Available from: https://www.gov.uk/government/publications/testing- for-coronavirus-before-hospital. 176. Department of Health and Social Care (England). Cohort pool testing for coronavirus (COVID-19) 2020. Available from: https://www.gov.uk/government/publications/cohort-pool-testing-for-coronavirus- covid-19. 177. Public Health England (UK). COVID-19: rapid point of care or near-person testing for service providers 2020. Available from: https://www.gov.uk/government/publications/covid-19-rapid-point-of-care-near- person-testing-for-service-providers. 178. Public Health Agency (Northern Ireland). COVID-19 antibody testing study: primary care and social care 2021. Available from: https://www.publichealth.hscni.net/covid- 19-coronavirus/guidance-hsc-staff-healthcare-workers-and-care-providers/covid-19- antibody. 179. Public Health Agency (Northern Ireland). Lateral flow testing for Health and Social Care staff 2020. Available from: https://www.publichealth.hscni.net/covid-19- coronavirus/guidance-hsc-staff-healthcare-workers-and-care-providers/lateral-flow- testing. 180. Public Health Agency (Northern Ireland). COVID-19: Regular programme of COVID- 19 testing in residential and nursing homes 2020. Available from: https://www.publichealth.hscni.net/covid-19-coronavirus/testing-and-tracing-covid- 19/testing-covid-19/covid-19-regular-programme-covid. 181. Public Health Agency (Northern Ireland). Testing for COVID-19 2020. Available from: https://www.publichealth.hscni.net/covid-19-coronavirus/testing-and-tracing-covid- 19/testing-covid-19. 182. Scottish Government (Scotland). Close contacts to be offered testing 2021. Available from: https://www.gov.scot/news/close-contacts-to-be-offered-testing/. 183. Scottish Government (Scotland). Coronavirus (COVID-19): getting tested in Scotland 2021. Available from: https://www.gov.scot/publications/coronavirus-covid-19- getting-tested/. 184. Welsh Government (Wales). Antibody testing: coronavirus (COVID-19) 2021. Available from: https://gov.wales/antibody-testing-coronavirus-covid-19. 185. Welsh Government (Wales). COVID-19 hospital patient testing framework: March 2021 2021. Available from: https://gov.wales/covid-19-hospital-patient-testing- framework-march-2021. 186. Welsh Government (Wales). Regional coronavirus testing facilities 2021. Available from: https://gov.wales/regional-coronavirus-testing-facilities. 187. Welsh Government (Wales). Care homes: coronavirus testing guidance 2021. Available from: https://gov.wales/care-homes-coronavirus-testing-guidance. 188. Ministry of Health Israel. Coronavirus (Covid-19) Frequently Asked Questions 2021. Available from: https://www.gov.il/en/departments/faq/faq-coronavirus. 189. Finish Institue of Health and Welfare (Finland). Procedure in case of suspicion of coronavirus COVID-19 infection 2021. Available from: https://thl.fi/fi/web/infektiotaudit-ja-rokotukset/taudit-ja-torjunta/taudit-ja- taudinaiheuttajat-a-o/koronavirus-covid-19/toimenpideohje-epailtaessa- koronaviruksen-covid-19-aiheuttamaa-infektiota. 190. Finish Institue of Health and Welfare (Finland). Guidance on the use of antigen tests in coronavirus diagnostics 2021. Available from: https://thl.fi/fi/web/infektiotaudit-ja- rokotukset/taudit-ja-torjunta/taudit-ja-taudinaiheuttajat-a-o/koronavirus-covid-

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19/koronaviruksen-covid-19-laboratoriotutkimukset/ohje-antigeenitestien-kaytosta- koronavirusdiagnostiikassa. 191. Finish Institue of Health and Welfare (Finland). Coronavirus tests 2021. Available from: https://thl.fi/en/web/infectious-diseases-and-vaccinations/what-s- new/coronavirus-covid-19-latest-updates/symptoms-and-treatment- coronavirus/coronavirus-tests.

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Appendix A – Latest summary epidemiological data by country Table A.1 Latest summary epidemiological data by country with weekly percentage change Country 14-day cases / 14-day deaths / Number in hospital Number in ICU / Testing rate per Weekly % test 100,000 population million population / million population million population 100,000 population positivity (weekly % change) (weekly % change) (weekly % change) (weekly % change) (weekly % change) (weekly % change) [18-Apr-21] [18-Apr-21] [11-Apr-21] [11-Apr-21] [11-Apr-21] ± [11-Apr-21] EU/EEA Austria 384.9 (-14.5%) 49.9 (4.2%) 189.3 (2.0%) 66.5 (6.6%) 23,228.9 (-4.7%) 0.9 (-11.2%) Belgium 422.8 (-10.5%) 49.9 (0.3%) 266.2 (5.5%) 77.6 (8.2%) 2,443.1 (-31.9%) 8.5 (18.2%) Czechia 466.8 (-23.3%) 138.3 (-23.4%) 490.1 (-17%) 110.4 (-16.6%) 9,805.5 (-4.1%) 2.6 (-23.0%) Denmark 160.8 (-4.7%) 4.5 (-3.7%) 36.4 (0.0%) 6.6 (-2.6%) 45,255.4 (33.3%) 0.2 (-33.7%) Finland 85.5 (-21.7%) 7.4 (-19.6%) 40.4 (-11.0%)* 7.4 (-19.2%)* 2,134.5 (-5.3%) 2.2 (-19.0%) France 685.8 (-9.0%) 59.9 (-1.7%) 450.1 (4.5%) 85.7 (9.3%) 3,874.7 (-26.4%) 9.1 (15.9%) Germany 309.4 (13.9%) 35.7 (17.7%) No data ‡ 54.5 (12.8%) 1,385.8 (-1.3%) 10.2 (6.8%) Ireland 108.6 (-16.3%) 23.9 (-0.8%) 43.1 (-12.0%) 10.7 (-8.6%) 2,192.6 (-7.2%) 2.6 (-16.5%) Italy 333.9 (-15.1%) 97.5 (-6.7%) 510.0 (-4.0%) 59.3 (-3.2%) 3,110.0 (-12%) 5.5 (-15.3%) Netherlands 609.4 (1.5%) 19.7 (-4.3%) 100.9 (8.9%) 46.0 (7.9%) 2,978.2 (-8.3%) 9.6 (12.6%) Norway 163.0 (-15.6%) 6.5 (25.0%) 50.9 (-7.7%) No data ‡ 3,431.0 (16.6%) 2.7 (-23.3%) Portugal 75.2 (8.2%) 6.5 (-16.5%) 45.7 (-9.9%) 11.1 (-3.4%) 3,388.3 (108.8%) 1.2 (-26.4%) Spain 227.4 (15.3%) 27.4 (-2.7%) No data ‡ No data ‡ 1,680.8 (25.4%) 7.4 (16%) Sweden 860.9 (12.4%) 28.7 (32.4%) 204.9 (9.4%) 37.0 (13.7%) 3,062.3 (0.0%) 13 (7.2%) Non-EU Israel 32.3 (-30.2%) 10.6 (-17.1%) 51.0 (-19.7%) 18.1 (-18.7%) No data† No data† United Kingdom 43.1 (-22.2%) 6.5 (-11.5%) 37.5 (-21.1%) 5.7 (-17.9%) No data† No data† Source: ECDC and OWID * Latest data for Finland on number of patients in hospital and ICU in Finland are for 9 April 2021 ‡ Daily hospital / ICU data are not available † Testing data for Israel, and the UK are not routinely captured by the ECDC. ± Includes RT-PCR and antigen tests

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Public health measures and strategies to limit the spread of COVID-19 Health Information and Quality Authority Appendix B – Developed frameworks for living with COVID-19 by country Table B.1 International frameworks for living with COVID-19 (extracted on 16 April 2021) Country Framework for living with COVID-19 Triggers to inform a change in public health measures Austria(4, 19, Austria uses a traffic light approach to determine the level of risk The evaluation of the current epidemiological situation at federal, state and district 122) of SARS-CoV-2 in different areas. level is carried out on the basis of four indicators: . Red: Very high risk: . Transferability (cases): The indicators “7-day number of cases” (new Uncontrolled outbreaks, large scale spread. cases that have occurred in the past 7 days), “7-day incidence” (new cases . Orange: High risk: that have occurred over the past 7 days per 100,000 inhabitants), “Number Accumulation of cases, no longer predominantly of new clusters within a calendar week"," Number of districts with new clusters. cluster cases within a calendar week" and "Number of cluster case-free . Yellow: Medium risk: districts within a calendar week" are intended to help assess the Moderate cases whose origin and distribution are epidemiological development of the SARS-CoV2 spread. known (= mainly in clusters). . Source search (cluster): The indicator “Cases with a clear source” . Green: Low risk: shows the traceability of the transmission chain as a result of Case & Individual cases, isolated clusters. Contact Tracing. . The newly occurring cases are also assessed with regard to their clinical manifestation of the SARS-CoV2 infection (symptomatic/asymptomatic). . Resources (in healthcare): Here indicators are used that show the existing and required supply capacities. They contain the current occupancy in normal and intensive care units as well as the current utilisation of the existing hospital capacities. . Tests: The indicators "tests per 100,000 inhabitants", “number of tests in the past 7 days” and the “positivity rate” (proportion of positive tests in all tests per region) allow statements about the test activity and provide information about the transmission in the respective region.

Ongoing evaluations The Corona Commission assesses the epidemic situation on the basis of various factors. These include: . Previous developments . Mobility of population . Regional particularities Traffic light colour is recommended at federal, state and/or district level.

Evidence-based ratings The decision on determining the traffic light colour is made at a political level. The competent authorities then set specific measures according to the traffic light colour by ordinance: . For Austria, the Minister of Health.

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Table B.1 International frameworks for living with COVID-19 (extracted on 16 April 2021) Country Framework for living with COVID-19 Triggers to inform a change in public health measures . For a federal state/ several federal states, the governors in coordination with the health minister. . For districts/regions, the district administrative authorities in coordination with the provincial governors and the health minister.

Targeted action A guideline for preventative measures in all areas of society/economy enables a largely uniform approach in similar epidemiological situations. Belgium(5, 123) The COVID-19 Control Tower is a system controlled by The following is also taken into account Sciensano which closely monitors the situation regarding the . Trend of the figures (upward or downward) number of coronavirus infections in Belgium. On the basis of the . Percentage of positive tests resulting figures, the control tower can assign a threat level at . Possible additional information relating to the nature of local outbreaks. national and provincial level. Each of these alert levels is linked to specific actions and there are also guidelines in In first instance, the number of infections per 100,000 terms of measures to be taken. These actions and measures are best taken and inhabitants over the previous 14 days is taken into account. The implemented as locally as possible, in consultation with the regional health agencies more infections in an area, the higher the level of alarm: and with a particular focus on vulnerable groups. Measures can also be phased out . No alarm: no or only a few sporadic infections on the basis of defined criteria for each threat level. For example, it can be decided . Pre-alarm phase: 1 to 14 infections to switch schools from code yellow to orange. It is the responsibility of the Minister . Alarm level 1: between 15 and 30 of Education to decide this in consultation with the local authorities. . Alarm level 2: between 31 and 50 . Alarm level 3: between 51 and 100 Additional federal measures can also be taken within alarm levels 3 and 4. . Alarm level 4: more than 100. An assessment is also made on a regular basis at the level of the municipalities. Based on: Other measures aimed at safe guarding schools are also in . Figures place. Under these measures schools are colour coded; under . Type of outbreaks ‘code yellow’ pupils can attend school at all levels of education. . Other previous criteria. Code yellow means that the virus is still present and active, but the situation is under control. This system will allow a normal If the situation evolves unfavourably for certain municipalities, the local crisis unit working week consisting of 5 days. may be asked to come together and analyse the situation and, if necessary, take additional measures. In municipalities experiencing peaks of infected people, the Ministers of Education can decide to move to ‘code orange’. Under ‘code orange’ certain changes will be made, such as the number of school days will be reduced. Czechia(6, 20, The Ministry of Health maps the current epidemiological The four indicators detailed below are taken into consideration when deciding what 124) situation using the anti-epidemic system (PES in Czech) risk level of risk to assign to each region: score. Based on the risk score, the regions will be assigned to 1 . 14-day number of positive for COVID-19 (per 100,000 inhabitants)

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Table B.1 International frameworks for living with COVID-19 (extracted on 16 April 2021) Country Framework for living with COVID-19 Triggers to inform a change in public health measures of 5 levels, on which the respective anti-epidemic measures will . How many seniors have recently become infected? 14-day number of depend. positive seniors (per 100,000 population aged 65 and over) . Simplified calculation of the reproduction number. In order to look at if the The risk scores corresponding to different levels of restrictive number of infected people is growing i.e. is the virus spreading in the measures are as follows: population Level 1: Green Risk score (0-20) . Proportion of hospitalisations, in the last 14 days State of caution: the epidemic is under control, the number of infected in the whole population is low, the epidemic is not The risk score associated with the level of each indicator is illustrated in the table growing significantly, testing and tracing contacts is effective, below. low risk community spread of the disease. Level 2: Yellow Risk score (21-40) Indicators and associated risk scores Attention status: local outbreaks of disease appear that 14-day number of positive for COVID-19 (per 100,000 inhabitants) require immediate anti-epidemic intervention with the protection <10 10-25 25-50 50-120 120-240 240-480 480-960 >960 of vulnerable groups, high emphasis on maximum effectiveness Risk 0 2 4 7 10 13 16 20 score of testing and tracing of contacts. 14-day number of positive seniors at COVID-19 (per 100,000 population 65+) Level 3: Orange Risk score (41-60) <10 10-25 25-50 50-120 120-240 240-480 480-960 >960 Emergency: the spread of the epidemic is growing, the Risk 0 2 4 7 10 13 16 20 pressure on the health care system is increased, the situation score requires intensive monitoring of the number of infected and Simplified calculation of the reproduction number hospitalised, high emphasis on maximum effectiveness of testing <0.8 0.8- 0.9- 1.0-1.1 1.1-1.2 1.2-1.3 1.3-1.4 1.4-1.6 1.6- ≥ 0.9 1.0 1.9 1.9 and tracing of contacts, high risk of community spread of the Risk 0 3 6 9 12 15 18 21 25 30 disease. score Level 4: Red Risk score (61-75) Proportion hospitalized in the last 14 days (%). Serious condition: the number of infected in the population is <7 17-20 20-23 23-26 26-29 29-32 32-35 35-40 40-45 ≥ high, there is a significant immediate risk of further deterioration 40 Risk 0 2 4 7 10 13 16 20 25 30 of the situation, tracing of contacts is limited, community spread score of the disease is taking place. Level 5: Purple Risk score (76-100) The final value of the risk index is obtained by summing the number of points Critical state: the total capacity of the hospital inpatient and allocated by value these four indicators. The more points, the higher the risk. The intensive care system is beginning to approach its limit, the resulting value of the index can take on range of values from 0 to 100. number of infected in the population is high, tracing of contacts is significantly limited, community spread of the disease is taking place. Denmark(7, 21, In dealing with the COVID-19 pandemic, the government and The individual risk assessments contain a quantitative and qualitative part, where 125-127) authorities have developed a national alert system so that it is the following factors are taken into consideration: transparent and predictable what tools are typically used to deal Quantitative factors: with the epidemic. . number of new infections per 100,000 inhabitants (the incidence),

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Table B.1 International frameworks for living with COVID-19 (extracted on 16 April 2021) Country Framework for living with COVID-19 Triggers to inform a change in public health measures As part of the national warning system for COVID-19, a so- . the proportion of positive samples out of the total number of samples (the called risk assessment is prepared once a week, in which it is positive percentage) assessed what health risk COVID-19 poses in Denmark. Based . the number of new patients admitted to the hospitals and the number of on the current risk assessment, the COVID-19 risk group patients in the hospitals' intensive care units are given importance. determines the national and regional risk level on a scale from Qualitative factors: 1-5. . number and size of certain outbreaks in the country, Risk level 1 reflects that the level of infection is low and that the . the age distribution among the infected, infection is typically seen locally. Risk level 5 reflects that there . the infection among health professionals is widespread infection in large parts of society, that the health . mortality service is under pressure and that there is a risk that the treatment capacity in the hospitals will be exceeded. An overall risk assessment is carried out at both national and regional level, taking the above factors into consideration. The level of risk in the regions may be different because outbreaks and infection development may be different locally and regionally. Therefore, measures and restrictions are not necessarily implemented geographically alike.

The national alert system does not specify in advance exactly which measures should be implemented or maintained at a given risk level. It will depend on the nature of the spread of infection and the specific risk assessment. Some measures can and should be maintained over a longer period of time, whereas others should be maintained for limited periods and / or areas due to the risk of negative spin-off consequences on e.g. mental health and economics.

Risk level 1: Low and local infection with possibility of flare-up. Risk level 2: Local and regional outbreaks of infection that can spread. Risk level 3: Widespread societal infection with potential for fast acceleration. Risk level 4: Widespread societal infection and pressure capacity on the hospitals. Risk level 5: Widespread societal infection, the healthcare system is under pressure and there is a risk that treatment capacity at the hospitals will be exceeded.

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Table B.1 International frameworks for living with COVID-19 (extracted on 16 April 2021) Country Framework for living with COVID-19 Triggers to inform a change in public health measures

On 7 April, the Danish Health Authority announced a gradual reopening plan. The plan details 4 phases of reopening with the first phase of reopening set to commence on 15 April. A detailed description of what restrictive measures will be lifted in each phase can be found here. Finland(9, 29, Previously Finland had developed a ‘Hybrid plan’ for living with Triggers used to inform the ‘Hybrid plan’: 128, 129) Covid-19. A region is put under one of the following categories . Number of new cases reported per 100,000 depending on its associated level of risk: . Number of tests  Dissemination (community transmission) phase: . Positivity rate the epidemic continues to grow - The growth of the . Source of infections epidemic continues to accelerate, cases spread . Incidence of covid-19 by age group regionally or more widely in the population, and tracing becomes more difficult. Criteria for Acceleration phase:  Acceleration phase: the epidemic is beginning to . 7-day cases are 10-15 / 100,000 inhabitants accelerate - The regional incidence of cases has . 14-day case amount does not exceed the level of 25 / 100,000 inhabitants increased, with several local and regional infection . proportion of positive samples is> 1% chains. . there are mass exposures  Basic level: the epidemic is not growing-Low . as a rule, the sources of infection can be identified incidence of infections, chains of infection manageable, . the need for hospital care can be met without special measures new cases individual. Criteria for Dissemination (community transmission) phase: On 9 April the Finnish government published a plan to lift the . 7 days cases are > 15 / 100,000 inhabitants restrictions imposed due to the COVID-19 epidemic, along with . 14 day cases are > 25–50 / 100,000 for at least two consecutive weeks a target timetable. The goal is to give the public, businesses and . the proportion of positive samples is> 2% communities a clear picture of how society could gradually . less than half of the sources of infection are identifiable reopen. A summary of the plan is detailed below. . the need for hospital care is growing and the number of new intensive care cycles is forecast to turn upward April – state of emergency ends The powers granted under the Emergency Powers Act will no Indicators to inform plan to lift restrictions: longer apply The Government will reassess the conditions for lifting the restrictions and update Transition to contact teaching (comprehensive school education the set timetable every two weeks. The impact of the decisions on the COVID-19 and upper secondary education) epidemic will be monitored and new restrictions can be dismantled every two to Restaurants will open with certain restrictions; opening hours three weeks. and the number of customers will still be restricted The government sets a target timetable for the controlled lifting of restrictions, which is completely dependent on: May – strict restrictions lifted . the development of the epidemic situation . and vaccine coverage

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Table B.1 International frameworks for living with COVID-19 (extracted on 16 April 2021) Country Framework for living with COVID-19 Triggers to inform a change in public health measures Restrictions imposed due to the threat of a fast acceleration of the epidemic will be removed; return to regional measures Restrictive measures will be lifted in April, May and June if the following targets are Children and young people may take part in outdoor group met: hobbies. Public and private premises (incl. libraries and museums) will April: Older people have received their first dose of the vaccine reopen. May: People in risk groups have received their first dose of the vaccine. Commuter traffic within the EU will be possible. June: Vaccination coverage of working-age population having received their first dose of the vaccine is more than 50%. June – regional restrictions gradually lifted Restrictions on gatherings will be eased Restrictions on restaurants’ customer seating and opening hours will be eased. Adults may take part in outdoor group hobbies Public events will resume with restrictions on the number of participants. Internal border control will end. Vaccination coverage of working-age population having received their first dose of the vaccine is more than 50%. France(130-133) The French Government does not have a set framework in 1. Epidemic activity (incidence rate) place. A variety of factors and triggers are taken into The incidence rate corresponds to the number of people who tested positive consideration before implementing or alleviating restrictions. (RT-PCR and antigen test) for the first time in more than 60 days compared to Measures referred to as ‘National Breaking Measures’ have been the size of the population. It is expressed per 100,000 inhabitants and makes it implemented since 3 April 2021 and are to remain in place for a possible to compare geographic areas with one another. period of four weeks in an attempt to curb the pandemic without taking a ‘lockdown’ approach. Three levels have been set for this indicator: Green: <10 people test positive out of 100,000 people, over a rolling week; Orange: >10 people tested positive out of 100,000 people, over a rolling week; Red: >50 people tested positive out of 100,000 people, over a rolling week.

2. Positive rate of virological tests The positivity rate corresponds to the number of people tested positive (RT- PCR and antigen test) for the first time in more than 60 days compared to the total number of people tested positive or negative over a given period; and who have never tested positive in the previous 60 days.

Three levels have been set for this indicator: Green: positivity rate between 0 and 5%. Orange: positivity rate between 5 and 10%.

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3. Virus reproduction factor (evolution of R0) The virus reproduction number: this is the average number of people that an infected person can infect. If the effective R is greater than 1, the epidemic develops; if it is less than 1, the epidemic decreases. This indicator, stopped on Tuesday and updated on Thursday, is an indicator of the epidemiological situation approximately 7 days previously and must be interpreted in the light of screening and data reporting activities. The indicator is updated once a week.

Three levels have been set for this indicator: Green: R0 between 0 and 1 Orange: R0 between 1 and 1.5 Red: R0 greater than 1.5.

4. Hospital pressure on resuscitation capacity This indicator reflects the level of demand for resuscitation but also the level of stress on hospital resuscitation capacities. This is the proportion of patients with COVID-19 currently in intensive care or in a continuous monitoring unit compared to the total beds in initial capacity, that is to say before increasing the capacity of resuscitation beds in a hospital.

Three levels have been set for this indicator: Green: occupancy rate between 0 and 30% Orange: occupancy rate between 30 and 60% Red: occupancy rate greater than 60%.

Other indicators taken into consideration when considering a change in public health measures include: . New confirmed cases: This indicator, available only at the national level, corresponds to the number of new cases tested positive for COVID-19 and reported since the day before. This indicator is very sensitive to the quality and rate of data feedback and does not exactly reflect the epidemiological situation of the day before. For example, the data reported at the start of the week are less numerous due to a decrease in laboratory activity on weekends.

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Table B.1 International frameworks for living with COVID-19 (extracted on 16 April 2021) Country Framework for living with COVID-19 Triggers to inform a change in public health measures . New patients in intensive care: This is the number of new patients with COVID-19 admitted to intensive care, or a continuous monitoring unit, during the last 24 hours. . Positivity rate: The positivity rate corresponds to the number of new people tested positive for COVID-19 compared to the total number of people tested for the first time over the same period. Thus, people performing several tests over the same period are not counted several times. . Number of people who received a first vaccine injection: Total number of first doses of vaccine injected. . Number of people who received a second vaccine injection: Total number of second doses of vaccine injected. . Vaccine doses in stock in health establishments: These data represent the stocks available in pivotal health establishments (hospitals and university hospital centres). These data are entered daily by the hub establishments. Germany(134) The Federal Chancellor and the Heads of Government of the In the past, indicators that had been taken into consideration when making Länder have developed a planning perspective on how and decisions about restrictive measures include: when restrictions can be lifted. There are a number of steps . New cases per 100,000 population per week. involved in lifting restrictive measures and a number of . R value. indicators that will be taken into consideration before moving to . Intensive care capacities. another step. . Rates of recovery. More recently, the 7-day incidence of new COVID-19 infections per week, per First step to ease restrictions: 100,000 population will be a key factor when deciding what step to move to with Possibility for private gatherings. regards to the easing of restrictions.

Second step to ease restrictions: Involves the reopening of bookshops, florists and garden centres which will be treated uniformly as retail for daily needs in all Länder.

Personal care service providers as well as driving schools and flight schools can also reopen with appropriate hygiene measures whereby a COVID-19 rapid test is performed or self- administered by the customer that day and testing for staff are required for the use of services in which a mask cannot be worn permanently, such as for cosmetics or shaving.

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Table B.1 International frameworks for living with COVID-19 (extracted on 16 April 2021) Country Framework for living with COVID-19 Triggers to inform a change in public health measures Third steps to ease restrictions: Includes but is not limited to: . Opening retailers with a limited number of customers being allowed on the premises depending on capacity (i.e. 1 customer per 10 sqm for the first 800 sqm of retail space, plus one customer for each additional 20 sqm). . Opening museums, art galleries, zoological and botanical gardens and memorials to visitors by prior appointment, with documentation provided for contact tracing. . Non-contact outdoor sports in small groups (max. 10 people) and also using outdoor sports facilities. . Opening retailers that operate click and collect. . Individual sport with a max 5 people from 2 households and sport in groups of up to 20 children up to 14 years of age outdoors and also using outdoor sports facilities.

Fourth steps to ease restrictions: Includes but is not limited to: . Opening outdoor cafés and restaurants to guests by prior appointment, with documentation for contact tracing; a COVID-19 rapid test or self-administered test of patrons performed that day is required for persons from more than one household who sit together at one table. . Opening theatres, concert and opera houses as well as cinemas for visitors with a COVID-19 rapid test or self- administered test performed that day. . Non-contact indoor sports as well as outdoor contact sports, provided that all participants have a COVID-19 rapid test or self-administered test performed that day.

Fifth steps to ease restrictions: Includes but is not limited to: . Opening leisure activities for up to 50 participants outdoors. . Non-contact indoor sports, outdoor contact sports (without testing requirements).

Further steps to ease restrictions:

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Table B.1 International frameworks for living with COVID-19 (extracted on 16 April 2021) Country Framework for living with COVID-19 Triggers to inform a change in public health measures . The prospects for establishments in the café and restaurant, cultural, events, travel and hotel sectors that have not yet been specified.

Note that the steps to ease restrictions detailed above are a summarised version of the report and do not include every detail relevant to each step. Ireland(33, 135) The framework that exists in Ireland consists of 5 levels: The following factors are also taken into consideration when making decisions about . Level 1 (least restrictive) whether to lift or re-impose restrictive measures: . Level 2 . The number, location and dispersion, and characteristics of cases and . Level 3 clusters, including the extent of secondary/tertiary spread. . Level 4 . 14-day and 7-day cumulative incidence, 5 day rolling average of cases by . Level 5 (most restrictive) county and nationally. The lower levels of the framework will be activated when there . Indicators of viral transmission (including the number of cases, positivity is low incidence of the disease, with isolated outbreaks, low rate(s) and the reproduction number). community transmission. The higher levels will be used to deal . Incidence, protective and outbreak management capacity in at risk settings with higher incidences of the disease. It is possible for different and vulnerable groups. regions and counties to be at a different level to the national . The capacity and performance of the programme of sampling, testing, level, depending on the incidence of the virus in that particular contact tracing and disease surveillance. region or county. . The capacity and resilience of the health service in terms of a. Hospital occupancy and new admissions b. Critical care occupancy and new admissions. . Numbers of deaths. . Other measures including infection prevention and control data and uptake of seasonal flu vaccine and the international situation. . These criteria will be considered collectively, in context and along with WHO and ECDC guidance to guide recommendations. A description of the combined trigger points for each level are explained in further detail in the Plan for Living with COVID-19 document referenced below.

With regards to the ‘Path Ahead’ plan, the following will be taken into consideration before making decisions in relation to the lifting of restrictive measures: . Disease prevalence (case numbers/incidence) is brought to much lower levels that can be managed and controlled by public health and that the reproduction number (“R” number) is such that we can be confident we can continue to suppress the disease e.g. at or below 1.

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Table B.1 International frameworks for living with COVID-19 (extracted on 16 April 2021) Country Framework for living with COVID-19 Triggers to inform a change in public health measures . Hospital and critical care occupancy are reduced to low levels to protect the health service and allow for the safe resumption of non-COVID-19 care. . Ongoing and steady progress on the vaccination programme such that the most vulnerable are protected through vaccination. . Emerging information on variants of concern. Italy(10, 18, 136) Regions and Autonomous Provinces are classified into four . 7-day incidence per 100,000. areas, according to the data and indications of the Control . Number of new reported cases in a week. Room/Cabina di Regia. Each area corresponds to different . Source of cases and the number of outbreaks. epidemiological risk scenarios and levels, namely: . Estimate of Reproduction number. . The most restrictive measures are in the red area, . Classification of risk (Moderate, Low or High). referring to the regions and autonomous provinces with a scenario of maximum severity and a high level of risk. Other indicators that are also being monitored include: . Slightly less restrictive measures are in the orange area, . Number of symptomatic cases reported per month including the regions and autonomous provinces with a high . Number of cases reported per month with a history of hospitalization (in severity scenario and a high-risk level. words other than ICU) . General restrictive measures in the yellow area. . Number of new transmission outbreaks (2 or more epidemiologically linked . No restrictions in the white area. together or an increase unexpected in the number of cases in a time and place defined) . Hospital and ICU capacity. Reopenings:

Yellow Areas:

. From 26 April, Some regions will be categorised ‘yellow areas’. In yellow areas priority will be given to outdoor activities, starting with restaurants with outdoor tables. Museums, theatres, cinemas and shows will be able to reopen (with capacity restrictions in ‘yellow areas’ . 15 May, Outdoor swimming pools can reopen

Yellow and Orange areas: . All schools in yellow and orange areas can reopen

Red areas: . Nursery schools and schools up to sixth grade will reopen

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It is planned that restaurants and gyms will be able to reopen indoors for lunch from 1 June. Netherlands(1 Every two weeks the coronavirus situation is assessed to see The risk level of each region is assessed on the basis of the number of new 2, 44, 137, 138) whether it is developing in a positive or negative direction. The confirmed cases and the number of hospital admissions. Below is an illustration and risk level in a particular region is based on the number of explanation of how the risk level in a region is assigned. positive tests and the number of hospital admissions. Each risk level is summarised below: Indicators used to determine associated Risk Level Indicators 1. Caution Risk Level* Positive tests per 100,000 Hospital admissions (inc. ICU) per The situation is manageable. The number of new confirmed inhabitants per week 1 million inhabitants per week cases is fewer than 35 per 100,000 inhabitants per week. There 1. Caution <35 <4 is sufficient healthcare capacity. 2. Concern 35-100 4-16 2. Concern 3. Serious 100-250 16-27 The situation is becoming difficult to manage. The number of 4. Severe >250 >27 new confirmed cases is between 35 and 100 per 100,000 *The number of new confirmed cases and the number of hospital admissions in a inhabitants per week. Pressure on healthcare capacity is region to determine the risk level. The highest figure is what counts. For example, if increasing. the number of new confirmed cases is at the ‘serious’ level and the number of 3. Serious hospital admissions is at ‘concern’, the risk level for the region will be set at The situation is serious. The number of new confirmed cases is ‘serious’. between 100 and 250 per 100,000 inhabitants per week. Pressure on healthcare capacity is very high. 4. Severe Indicators used to determine associated Risk Level (in the Roadmap for measures) The situation is severe. The number of new confirmed cases is Indicators higher than 250 per 100,000 inhabitants per week. Pressure on Risk Positive Hospital ICU admissions Hospital healthcare capacity is extreme. Level* tests per admissions nationwide per admissions

100,000 (inc. ICU) day (during 2 (including ICU) On the 8 March 2021, the Central Government of the inhabitants per 1 million weeks) nationwide per dat Netherlands published a Roadmap for measures. The roadmap per week inhabitants contains 4 risk levels. The Netherlands is currently classified at per week risk level 4 (very serious). That's the toughest level. For each

risk level, the roadmap shows the measures that apply at each 1. Caution <35 <4 <3 <12 level, for example, to home visits, work, marriages, funerals and 2. Concern 35-100 4-16 <10 <40 cremations. But also for catering, education, childcare and 3. Serious 100-250 16-27 <20 <80 contact professions, for example. The basic measures against 4. Severe >250 >27

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Table B.1 International frameworks for living with COVID-19 (extracted on 16 April 2021) Country Framework for living with COVID-19 Triggers to inform a change in public health measures the corona virus always apply to everyone. For example, wash your hands often and keep a distance of 1.5 meters. The content of the roadmap will be regularly updated to reflect new developments, including, but not limited to: . new variants of the virus . the effect of measures . vaccination coverage . information in relation to COVID-19 testing. Norway(11, 30) A 3 level system of regional measures are in place, Level A, Before moving on from one step to the next, these three aspects will be assessed: Level B and Level C. These regional measures can be imposed . Infection rates and the disease burden on top of more general national measures. Level A encompasses . The capacity of the health care services particularly strict measures, while Level C encompasses much . Vaccinations. less strict measures. Additionally, local municipalities can apply even stricter measures than those indicated nationally or regionally. The government can decide which measures are to be implemented in a municipality and surrounding municipalities in the event of an outbreak of infection. It will always be the most stringent measures introduced in an area (i.e. local, regional, and national) that apply. The restrictions applicable under each level are detailed here.

On April 10 Norway published a plan for reopening. The reopening plan of Norway is not scheduled on specific dates, but it clarifies the conditions that must be met for the reopening to happen. The plan also sets out the order in which the various parts of society will reopen. Data, not dates, decide the pace of the reopening process. Children and young people will be prioritised; next, jobs and the business sector.

The Government’s reopening plan consists of four steps, with an overview of which restrictions will be eased at each step.

Step 1: Easing the restrictions implemented before Easter. This will, among other things, involve considering allowing:

. a maximum of five guests in private homes . events only bringing together participants from one single municipality to go ahead as planned

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Table B.1 International frameworks for living with COVID-19 (extracted on 16 April 2021) Country Framework for living with COVID-19 Triggers to inform a change in public health measures . the serving of alcohol to be permitted until 22:00 hrs, but only to guests also being served food . changing the recommended safe distance back to 1 metre . a maximum of 100 persons at indoor events such as cultural and sporting events, conferences and religious services, where all attendees are assigned fixed seats . a maximum of 200 persons at outdoor events, but 3 cohorts of 200 persons each if spectators are assigned fixed seats.

Step 2: The opening up will include allowing:

. increased access to in-person teaching sessions at universities, university colleges and vocational schools . a cautious increase from five to ten guests in private homes, because we know that many people have been infected in this very context . a maximum of 20 persons at private events held at hired public venues . the serving of alcohol until midnight, with no requirement of serving food to guests . a maximum of 200 persons at indoor events where all attendees are assigned fixed seats . children and young people to participate in events and organised training sessions taking place in the municipality where they live, with a maximum of 100 attendees at indoor activities . a gradual reopening of organised training in recreational sports for groups of maximum 20 adults, both for outdoor and indoor activities. . By mid-April, the health authorities will suggest a model for the reopening of recreational sports . The recommendation to avoid travelling abroad still applies unless strictly necessary. For travellers entering Norway, strict requirements to undergo entry quarantine and mandatory testing will still apply.

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Table B.1 International frameworks for living with COVID-19 (extracted on 16 April 2021) Country Framework for living with COVID-19 Triggers to inform a change in public health measures . Restrictions will be eased for family visits from abroad, applying both to family members from within the EEA area and family members who are third-country nationals. We will, among other things, consider opening up for visits from romantic partners and grandparents living abroad. . Restrictions will also be eased for prioritised groups of employees who need to travel to and from Norway.

Step 3: In this phase we may see ease restrictions further, both in the private and the public sphere.

. A maximum of 20 guests will be allowed in private homes. Private events held at hired public venues may have a maximum of 50 guests. . Special considerations will be made about public events relating to the possible use of rapid tests and corona certificates. The cut-off time for serving alcohol will revert to normal, but it will still be required to register guests and maintain safe distances. . We will still prefer that as many people as possible work from home. . For adult recreational sports, we will consider a gradual opening up for league matches and other competitions. . Elite athletes may at this stage practice their sports more or less as before restrictions were implemented. . We will also permit more international travel, though quarantine and testing requirements will still apply. However, these requirements may be changed as of today. We will also consider how corona certificates may be used for travelling abroad. . Employment immigration will be allowed to a greater degree.

Step 4: Much of everyday life will be almost back to normal. However, infection control measures will still apply, as will the requirement to keep a safe distance and to stay at home if you

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. The permitted number of spectators/participants attending big public events and recreational sports and leisure activities will remain limited and will be continuously assessed. . Restrictions on entry to Norway may still apply, particularly for third-country nationals. . Travellers must expect requirements to quarantine upon arrival in Norway and to be tested when arriving from certain areas. . The rules for travelling to Norway must also be assessed continuously.

What each step will entail may change based on, for example, new knowledge about how infections spread and the experience of the reopening process. Therefore, the Norwegian Government plan to make a new assessment of the plan before summer. Portugal(13, 28, Municipalities are assigned to one of the below levels of risk Exceptional measures are currently in place in 121 municipalities. The decision on 35) depending on the epidemiological situation in each municipality: which municipalities would be covered by the new measures was based on three . Moderate: Municipalities with less than 240 cases per criteria: 100,000 inhabitants in the last 14 days. . 240 new cases per 100,000 inhabitants in the last 14 days. . High: Municipalities with a number of cases between . Proximity to another municipality that fulfils the first criterion. 240 and 479 per 100,000 inhabitants in the last 14 . Not considering outbreaks in low-density counties. days. . Very high: Municipalities with a number of cases Plan for Easing State of Emergency: between 480 and 959 per 100,000 inhabitants in the The timetable foreseen for the different phases of deflation can be altered in view of last 14 days. certain epidemiological criteria for the definition of pandemic control and also . Extremely high: Municipalities with more than 960 considering the existence of an assistance response capacity by the National Health cases per 100,000 inhabitants in the last 14 days. Service. The most restrictive measures will be implemented in municipalities associated with ‘extremely high’ risk, with the least restrictive measures implemented in municipalities with ‘moderate’ risk.

A State of Emergency and national lockdown was subsequently put in place across Portugal on 15 Jan 2021.

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Table B.1 International frameworks for living with COVID-19 (extracted on 16 April 2021) Country Framework for living with COVID-19 Triggers to inform a change in public health measures

Plan for Easing State of Emergency The Portuguese Government has established a deconfinement plan for easing the State of Emergency. It is divided into 4 phases with a period of 15 days between each phase in order to be able to assess the impacts of the measures on the evolution of the pandemic. The plan details easing of restrictions which will occur between 15 March and 3 May. Not all restrictions will be eased as of 3 May with further details of the plan to be provided in due course. Spain(139, 140) The indicators for risk assessment detailed in Table A will be Table A: Indicators for risk assessment taken into consideration when deciding what territories fall into each level of risk. BLOCK I: Evaluation of the transmission level

Alert level 1: When at least two indicators from block I and Indicators for alert levels Low Medium High one from block II are at low level Incidence accumulated cases >25 to ≤50 > 50 to ≤150 > 150 to ≤250 Alert level 2: When at least two indicators from block I and diagnosed in 14 days one from block II they are in the medium level Incidence accumulated cases > 10 to ≤25 > 25 to ≤75 > 75 to ≤125 Alert level 3: When at least two indicators from block I and diagnosed in 7 days one from block II are at high level Incidence accumulated cases > 20 to ≤50 > 50 to ≤100 > 100 to ≤150 Alert level 4: When at least two indicators from block I and 65 or over diagnosed in 14 one from block II they are at a very high level days Incidence accumulated cases > 10 to ≤25 > 25 to ≤50 > 50 to ≤75 From block I, only one of the two general indicators of the 65 or over diagnosed in 7 days accumulated incidence will be taken into account, both for Global positivity of PDIA by > 4% to > 7% to > 10% to global AI and incidence in> 65 years: if there is no delay in week ≤7% ≤10% ≤15% notification, AI will be used in 7 days and otherwise, 14 days. Percentage of cases with ≤80% to> ≤65% to> ≤50% to> The indicators for risk assessment detailed in Table 1 will be traceability 65% 50% 30% taken into consideration when deciding what territories fall into each level of risk. The most restrictive measures will be imposed BLOCK II: Level of use of healthcare services due to COVID-19 in areas associated with the most risk. Occupation of beds of > 2% to > 5% to > 10% to

hospitalization for COVID-19 ≤5% ≤10% ≤15%

cases Occupation of care beds critical > 5% to > 10% to > 15% to for cases of COVID-19 ≤10% ≤15% ≤25%

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Table B.1 International frameworks for living with COVID-19 (extracted on 16 April 2021) Country Framework for living with COVID-19 Triggers to inform a change in public health measures

The combination of the result of the indicators, positions the territory evaluated at a level of risk that corresponds to four levels of alert, from 1 to 4. The final decision on the level of alert assigned to the evaluated territory is based not only on the level of risk resulting from the combination of the main indicators, but will be modulated according to the level of risk of the complementary indicators, as well as other variables related to the context, socioeconomic, demographic and mobility of the evaluated territory.

Sweden(141, The Swedish Government does not have a set framework of It is unclear what triggers will be taken into consideration when deciding on 142) restrictions in place. However, The Government has adopted a whether or not to impose restrictions. However, it has been previously noted that Government Bill for a temporary Act to prevent the spread of the starting point has been that the measures taken to reduce the spread of COVID-19. The legislation is intended to give the Government infection are to be characterised by persistence and participation, taking into the authority to adopt more binding communicable disease account the effects on society and public health in general. control measures than was previously possible. The Act entered into force on 10 January 2021 and is in effect until 30 September 2021. England(8, 23, Prior to current lockdown, England used a three tiered system of In relation to the three tiered system implemented by the UK, the following 143, 144) restrictive measures. indicators were taken into consideration before implementing or easing restrictive The three local COVID-19 Alert levels include: measures: . Alert Level - Medium . number of new infections of the disease identifies during a specific time . Alert Level - High period (incidence) . Alert Level - Very High . the estimate of R and growth rate Alert levels were assigned to different regions depending on the . proportion of the population that test positive for the disease in the prevalence of COVID-19 in that area. community at any given point in time (positivity rate or prevalence) . data on testing, cases, healthcare and deaths. COVID-19 Response - Spring 2021 On the 22 Feb 2021, the UK Government published a document COVID-19 Response - Spring 2021 outlining the roadmap out of lockdown. This plan consists of 4 The design of the roadmap has been guided by some important principles. Decisions steps. Step 1 of the plan commenced on 8 March and Step 4 is on easing restrictions will be led by data rather than dates. It takes around 4 weeks set to take place no earlier than 21 June 2021. for the data to show the impact of easing restrictions and the Government will provide a further week’s notice to the public and businesses ahead of any further changes. For that reason, there will be at least 5 weeks between the steps in the roadmap. The indicative, ‘no earlier than’ dates in the roadmap are all contingent on the data and subject to change.

Before taking each step, the Government will review the latest data on the impact of the previous step against 4 tests. The tests are:

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Table B.1 International frameworks for living with COVID-19 (extracted on 16 April 2021) Country Framework for living with COVID-19 Triggers to inform a change in public health measures . The vaccine deployment programme continues successfully. . Evidence shows that vaccines are sufficiently effective in reducing hospitalisations and deaths in those vaccinated. . Infection rates do not risk a surge in hospitalisations which would put unsustainable pressure on the NHS. . Assessment of the risks is not fundamentally changed by new Variants of Concern. Northern On the 2 March 2021, the Northern Ireland Executive published Following an increase in coronavirus (COVID-19) cases, additional restrictive Ireland(24, 53, a guidance document, ‘Moving Forward’, detailing a pathway out measures are implemented for people living in Northern Ireland. The reproductive 145) of restrictions. The guidance document details 5 stages moving number (R) helps inform decision making with regard to social distancing and other from lockdown restrictions to cautious first steps, gradual restrictions. The Executive has indicated that keeping R below 1 is a key objective. easing, further easing and the future. The Executive has committed to a 4-week review cycle, where they will monitor the In relation to the plans to reopen, the following factors will be taken into data on a range of health and societal impacts, before consideration: considering what relaxations can be made safely. The dates for Health Trends (set figures not specified) comprehensive formal reviews by the Executive are: 16 March, . Rates of virus transmission and incidence. 15 April, 13 May and 10 June 2021. . Healthcare capacity (COVID and non-COVID). . Population immunity and vaccination. Community Trends . Mental health and physical wellbeing. . Education of children and young people. . Impacts upon vulnerable people. Economy Trends . Impact on businesses/sectors. . Impact on employees. . Availability of economic support packages. Scotland(26, Previous framework: Indicators relevant to previous framework: 146) Previously, Scotland had a 5 level protection plan, with levels The protection levels are reviewed weekly. The following factors are taken into ranging from 0 to 4 inclusive. Level 0 was associated with the consideration when deciding what level of restrictions should be implemented in lowest level of risk and level 4 associated with the highest level each region: of risk. . Number of cases per 100,000 people over the past 7 days. . Percentage of tests that are positive over the past 7 days Updated framework: . Forecasts of the number of weekly cases per 100,000 in 2 weeks’ time More recently, the framework has been updated, with the 5 . Current and projected future use of local hospital beds, compared with level protection plan ranging from level 0 to 4 still being applied. capacity Additionally the updated framework details plans for a gradual . Current and projected future use of intensive care beds, compared with easing of restrictions with a minimum 3 week gap between each capacity. phase of reopening. The measures that are applied under each

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Table B.1 International frameworks for living with COVID-19 (extracted on 16 April 2021) Country Framework for living with COVID-19 Triggers to inform a change in public health measures level of the framework are detailed here. Each phase of easing Indicators relevant to updated framework: restrictions will be conditional on 6 conditions: Some indicators that will be taken into consideration before moving between levels 1. Transmission is controlled. of the updated framework are illustrated in the table below, where a comparison is 2. Sufficient public health and health system capacities made between the Scottish guidance and the WHO guidance. Scotland will continue are in place. to give careful consideration to WHO advice as it continues to develop and they will 3. Outbreak risks are minimized in high vulnerability seek to tailor such advice to Scotland’s particular circumstances where appropriate. settings. 4. Preventative measures are established in work places. A number of other indicators including vaccinations will also be taken into 5. Manage the risk of exporting and importing cases. consideration. More clarity around indicators and data that will be taken into 6. Communities have a voice, are informed, engaged and consideration will be published in a separate analytical paper in due course. participatory in the transition. WHO advised indicators compared to Scotland’s current indicators. Adapted from Scotland’s Strategic Framework Level 0 Level 1 Level 2 Level 3 Level 4 Weekly Scotland’s <20 20-75 75-150 150-300 300+ cases/ current 100k range WHO range Close to <20 20-50 50-150 150+ 0 Test Scotland’s <1.5% 1.5-3% 3-5% 5-10% 10%+ Positivity current range WHO range Close to <2% 2-5% 5-20% 20%+ 0

Wales(16, 147) The Welsh Government published their risk framework in Alert level one indicators: January 2021. The framework consists of 4 risk levels, with the This represents the closest to normality that is likely to be experienced until the least amount of restrictions under alert level 1 and the most summer and the widespread roll-out of vaccines. At this alert level the following restrictions associated with alert level 4 as follows: might be expected: . All new infections being reported can be accounted for by contact tracing Alert level one (low risk) teams. This represents the level of restrictions closest to normality, . Low levels of community transmission and no evidence of wider which are possible while infection rates are low and other transmission. preventative measures, such as social distancing and working . Minimal introduction of infection into closed settings (such as care homes, from home, remain in place. schools, and prisons). . Sustained low incidence rates. Slightly higher incidence rates may be Alert level two (medium risk) tolerable if explained by outbreaks being understood and managed.

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Table B.1 International frameworks for living with COVID-19 (extracted on 16 April 2021) Country Framework for living with COVID-19 Triggers to inform a change in public health measures This includes additional controls to limit the spread of Alert level two indicators: coronavirus. These may be complemented by more targeted This includes additional controls to ensure sustained low incidence (consistent with local actions to manage specific incidents or outbreaks. alert level one). These may be complemented by more targeted local restrictions put in place by incident management teams and others to manage specific incidents Alert level three (high risk) or outbreaks. At this alert level the following might be expected: These represent the strictest restrictions short of a firebreak or . Almost all new infections reported are responded to by contact tracing lockdown. This responds to higher or rising level of infections teams. where local actions are no longer effective in containing the . NHS Wales Test Trace Protect evidence shows, while the majority of cases growth of the virus. can be accounted for, there is emerging evidence of onward transmission from previously identified risks. Alert level four (very high risk) . There is increasing introduction of infections in closed settings, such as Restrictions at this level would be equivalent to the firebreak care homes, and in the community. regulations or lockdown. These could either be deployed as a . Likely to be multiple clusters and increased community transmission. preventative firebreak or as a lockdown measure. Alert level three indicators: A summary of the restrictive measures that are in place under This represents the strictest restrictions short of a firebreak or lockdown. At this each alert level can be found via the hyperlinks below: alert level, the restrictions at alert level two and supportive local actions are no Alert level 1 longer effective in containing the growth of the virus or a wider spread. At this alert Alert level 2 level the following might be expected: Alert level 3 . Not all new infections are being investigated. Alert level 4 . Resources are targeting clusters and incidents in high risk settings (for example care homes). Wales are currently transitioning out of Alert level 4 and to Alert . Widespread community transmission evidenced by number of small level 3. Upcoming lifting of restrictive measures include: household and social clusters which cannot be linked. Significant impact on closed settings. From 24 April: . Numerous cases which are linked to workplaces. 6 people from 6 households will be able to meet outdoors (not . Hospital admissions increasing on a trajectory that would lead to including children under 11 years of age or carers from those unsustainable levels and care homes in red, delaying discharge and households). causing bottlenecks. . Incidence rates in the over 60s increasing. From 26 April: Outdoor hospitality can open. Alert level four indicators: If public health conditions permit, the following relaxations can Restrictions at this level would be equivalent to a firebreak or lockdown. At this alert go ahead: level the following might be expected: . organised outdoor activities will be permitted for up to 30 . Very high or exponential growth of cases with widespread introduction into people closed settings. . outdoor wedding receptions will be permitted for up to 30 . NHS Wales Test Trace Protect is prioritising the most vulnerable, and people backward contact tracing is no longer feasible as there are too many cases.

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Table B.1 International frameworks for living with COVID-19 (extracted on 16 April 2021) Country Framework for living with COVID-19 Triggers to inform a change in public health measures . outdoor visitor attractions can open. . Epidemiological review shows random spread of virus across Wales without a comprehensive understanding of transmission drivers. . Evidence that national and local mitigating measures no longer proving effective. . Health and social care under significant pressure and not sustainable, elective procedures are being cancelled across the board and capacity limits reached or about to be breached. Israel(32, 41, In Israel, a traffic light plan for restrictions consists of four To inform what traffic light colour is applied, the following indicators are taken into 148) colours; red, orange, yellow and green. Each colour is consideration: associated with different levels of restrictions with areas falling . Percentage of positive tests. under the red traffic light having the most restrictions imposed . New patients per 10,000 people. and those under the green traffic light having the least restrictions. Traffic light plan: Red: minimal activity Orange: limited activity Yellow: limited activity Green: extended activity

Vaccination and the Green Pass (plan for reopening) What is a Green Pass? The Green Pass is an entry permit to places or facilities for recovered coronavirus patients and vaccinated people.

Who is eligible for a Green Pass, and what is the limitation of the Pass? The Green Pass is personal and is given to any person who is vaccinated for coronavirus, or people who recovered from coronavirus. No others are eligible for the Green Pass at this stage. Each group has a different limitation on the Pass: - Vaccinated individuals: the Pass is valid for six months (similar to the vaccination certificate), effective the week after receiving the second dose for six months. - Recovered coronavirus patients: the Pass is valid until 30 June 2021.

Green Pass Establishments

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Table B.1 International frameworks for living with COVID-19 (extracted on 16 April 2021) Country Framework for living with COVID-19 Triggers to inform a change in public health measures Who can be admitted into establishments that comply with the Green Pass restrictions? - Vaccinated individuals – any individual who received 2 doses and at least a week has passed since the administration of the second dose (people with a vaccination certificate). - Recovered individuals – people with a certificate of recovery who were confirmed coronavirus patients or who people who have a positive serological test result. - One-year olds or younger. - At this stage, people undergoing testing or children under 16 years of age who are not recovered coronavirus patients will not be admitted. - There are exceptions for event venues and gardens as well as for admitting children to hotels.

How is the Green Pass used? You may enter establishments or events that comply with Green Pass restrictions, if you present the Pass (either printed or on an App) with an identification document or if you show a vaccination certificate or a recovery certificate.

What are the rules when in an establishment complying with Green Pass restrictions? - Even in establishments that comply with Green Pass restrictions, it is important to continue practicing the public behaviour rules to reduce the risk of infection. - Occupancy restrictions must be observed by every location.

Some locations are allowed to operate under a purple pass/badge, under the purple pass these locations can open while adhering to occupancy restrictions. The locations that can operate under the purple pass and the corresponding occupancy restrictions are detailed below.

Locations operating the purple pass: . Restaurants and coffee shops (for outside seating) . Stores, malls and shopping centres

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Table B.1 International frameworks for living with COVID-19 (extracted on 16 April 2021) Country Framework for living with COVID-19 Triggers to inform a change in public health measures . Synagogues, mosques, churches, and other houses of prayer (Limit on gathering: 20 inside, 100 outside) . Alternative medicine, hairdressers, and beauty treatments . Markets . Outdoor swimming pools . Outdoor attractions . Outdoor extracurricular activities for children . Museums . Libraries . Bed and breakfasts . Parks and nature reserves.

Occupancy restrictions: . Distance of 1:15 meters squared per person or in specified locations . In any case- basic restrictions on occupancy are as follows: . 20 people indoors . 100 people outdoors . 100 people in locations with both indoor and outdoor areas

Current restrictions in Israel have been extended to remain in place until 28 April, schools will also reopen for all age groups from 18 April.

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Public health measures and strategies to limit the spread of COVID-19 Health Information and Quality Authority Appendix C – International testing strategies Table C.1 International strategies for the detection of current infection with SARS-CoV-2 (extracted on 16 April 2021) Country Testing strategy Expanded use of testing (e.g., Use of rapid or near-patient testing (for Population-wide testing screening) the detection of current infection) Austria(89, 119, Testing strategy consists of Vulnerable groups, such as the Rapid antigen for Population-wide voluntary testing was 149, 150) two main pillars: residents of residential and care 1. Symptomatic at GPs, hospitals pre- conducted in Austria in December. All 1. Test symptomatic homes. admissions and outpatient departments, positive tests followed up with PCR individuals and close contacts; The staff caring for vulnerable RCFs and schools. test, the person concerned will be 2. Test asymptomatic groups including hospital settings. 2. Asymptomatic individuals in outbreak officially segregated and retested individuals as part of screening Occupational groups with a higher management. Companies with more than within 24 hours. If confirmed by the programs, outbreak risk of infection and transmission, 50 employees are advised to establish PCR test, the immediate official investigations and identified especially health care staff and their own test lines or test facilities and separation of the contact persons of contacts; occupations that provide services to offer free antigen rapid tests and PCR the past 48 hours takes place. 3. Population wide testing for with close physical contact to tests. Mobile testing team on site at Tests are available free of charge for infection control. others, or who have frequent companies with more than 100 people without COVID-19 symptoms at personal contact to others. employees. Company tests can also be public testing sites as well as Target group-specific screening for offered to relatives, customers and participating pharmacies. It is high risk settings. people from other companies. Self-tests recommended that everyone should Screening of admissions and are available at pharmacies free of get tested once or twice a week, and readmissions of residents and charge; however, a negative result always before seeing a vulnerable visitors to RCFs. obtained via self-testing cannot grant person. Screening of students (mandatory) access to specific locations. Administered and staff (voluntary): test valid for 7 days as proof of - At elementary and special schools, participation for employers as mandatory self-tests (anterior-nasal tests) will weekly professional group test. Self-tests be carried out three times a week. cannot be used as such evidence. - At all other schools once a week. All positive tests followed up with PCR - Boarding school students on first test at the same test location. arrival at the boarding school.

Belgium(62, 85, Laboratories prioritise samples Screening of new residents in RCFs, Rapid antigen tests can be used for: None underway. 109, 151, 152) for testing: new residents with a risk profile in 1. Symptomatic individuals with 1. Symptomatic patients, with other care institutions, and symptoms for ≤ 5 days presenting at Preventative testing in local particular attention to critically hospitalised persons. emergency services; hospitals; triage and communities is "not recommended and ill patients, health Repeated screening of staff at RCFs collection centres; GP practices. not reimbursable" in all three phases professionals and people over and also home nurses according to 2. Asymptomatic individuals, in the of the pandemic (pre-alarm, alarm and 65 years of age and suffering the epidemiological situation and if context of cluster research (≥2 cases) in epidemic). from co-morbidities the vaccination rate for residents group settings with a low-risk profile (not 2. Clusters/homes within <90% or staff members <70% RCFs): essential services, e.g. police, fire communities, both within and Optional screening of visitors to brigade etc.; education, childcare, youth

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Table C.1 International strategies for the detection of current infection with SARS-CoV-2 (extracted on 16 April 2021) Country Testing strategy Expanded use of testing (e.g., Use of rapid or near-patient testing (for Population-wide testing screening) the detection of current infection) outside care institutions RCFs and only if vaccination rate assistance; essential sectors and 3. Screening new residents in residents <90% companies. All positive test result RCFs; new residents with a Optional repeatedly testing in other followed up with PCR test. risk profile (over 65 years of populations and only if certain Pilot projects are ongoing to evaluate the age or co-morbidities) in other conditions are met. use of antigen tests in the context of care institutions; and Screening of all asymptomatic cluster investigation in RCFs, and for the hospitalised persons. people following high-risk contact testing of high-risk contacts in schools at identified based a self-assessment the start of their quarantine. tool. Currently, the testing capacity is considered insufficient to systematically test low-risk contacts. Screening students and staff in the context of clusters. Pooling of samples can be used for screening of large asymptomatic populations expected to have a low prevalence. A large-scale pilot has begun investigating whether weekly PCR screening using morning saliva on all staff can effectively prevent outbreaks in non-infected RCFs. In Antwerp, saliva PCR tests are being compared with deep-nose PCR tests in secondary schools. Czechia(55, 63, Testing is provided for Screening of all staff and residents Antigen testing allowed only on Close-to-blanket testing using rapid 105, 106, 110, 153) symptomatic individuals and of LTCFs at least once every 5 days. asymptomatic people: antigen tests have been conducted close contacts, as well as high- Screening all staff at social service Screening staff and residents in LTCFs (for example, via free self-requested risk groups (for example, providers and outpatient and outpatient facilities. All positive tests and mandatory workplace patients with comorbidities). departments at least once every 5 results with no symptoms, or negative testing) All health insurance days. results and symptoms, followed up by policyholders (mandatory in Screening of visitors on arrival to all PCR test. Czechia) can request an healthcare services including LTCFs. Screening visitors to LTCF and other antigen test regardless of Screening of all employees in healthcare facilities. symptoms or close contact companies who employ at least 10 Screening of teaching staff and students. status free of charge once people, self-employed persons and Workplace screening using self-tests and every five days. all non-governmental non-profit POC antigen tests. organisations at least once every 7

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Table C.1 International strategies for the detection of current infection with SARS-CoV-2 (extracted on 16 April 2021) Country Testing strategy Expanded use of testing (e.g., Use of rapid or near-patient testing (for Population-wide testing screening) the detection of current infection) days, for entry to workplace or visiting a client. Screening of pupils twice a week In all cases testing is not required for people with a positive PCR result within 90 days or tested in the previous 48 hours or are vaccinated (14 days after final dose). Denmark(56, All citizens aged 2 and over Regular screening of staff at all Antigen testing allowed only on Wide spread availability of and 100, 154, 155) can request a PCR or antigen healthcare services and LTCFs asymptomatic people: requirement for testing using PCR and test. where there are people at increased Close contacts identified via contact rapid antigen tests is now in place Priority is given to risk at COVID-19, up to twice a tracing app. across both health and community symptomatic individuals in week (PCR only). Fully vaccinated Screening at educational institutions, settings in a strategic drive to reopen need of medical attention, staff (14 days after final dose) can employees at workplaces, and selected society. close contacts of confirmed refrain from testing if more than age groups or areas where there is a cases, and residents/patients 80% of residents are fully widespread spread of infection. and staff in healthcare vaccinated. Screening of low risk contacts in the facilities. Screening of patients / citizens and event of an outbreak of infection in a staff in the health and elderly workplace, schools, institution, etc. sector, residences, closed Selective urgent situations where institutions, etc. if COVID-19 is simultaneous PCR testing must also be detected at the department / performed, such as patients presenting at institution (PCR only). admission with symptoms that are Routine testing of staff in the care compatible with COVID-19 so that and hospital sector (PCR only). relevant treatment can be initiated or for Screening at admissions at hospitals outbreak managements in a RCF or other (PCR only). LTCF to screen residents and staff for an Regular or as a point testing of staff immediate decision to initiate cohort and students age 12 and older at isolation. schools and other educational Regular screening of employees in institutions in connection with occupations where physical attendance is reopening. necessary and where epidemic Screening of people working in knowledge dictates many outbreaks, e.g. certain occupations. slaughterhouses, construction sites and Screening of staff in regions of high prison staff. infection levels. When used in regular screening an Screening in connection of interval of between 3 and 4 days is outbreaks (PCR only). recommended.

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Table C.1 International strategies for the detection of current infection with SARS-CoV-2 (extracted on 16 April 2021) Country Testing strategy Expanded use of testing (e.g., Use of rapid or near-patient testing (for Population-wide testing screening) the detection of current infection) Screening of visitors and spectators etc. at major cultural and sporting events. If antigen testing is used outside of screening scenarios, a negative test result should always be followed up with a PCR test. Not allowed for use in testing relatives of particularly vulnerable people prior to visiting, for example screening RCF visitors. France(58, 65, Anyone in France can request Individuals considered medically Rapid antigen for: No population wide screening 156-158) a PCR test free of charge. vulnerable and their caregivers. 1. Symptomatic individuals ≤ 4 days. programme in place, but there is wide Priority is given to Individuals who live in areas with Positive results for individuals aged 65 or spread availability of tests with symptomatic individuals, close high transmission rates. over and people who present with at virological screening "at the slightest contacts, and nursing or Residents of LTCFs and other high least one risk factor, as defined by the doubt" in all places of life and local similar staff. risk settings in the event of the first High Council of Public Health, must be actors have the ability to quick deploy confirmed case. followed up with PCR test. test campaigns in their local Territories identified as vulnerable 2. Asymptomatic individuals when they catchment area. because of their density or the are contacts detected individually or distance from access to care. within a cluster and symptomatic people Companies that suspect a cluster within the first 4 days after the onset of among its employees can organise a symptoms, screening RCF, and as part of collective screening operation after a diagnostic process, if the professional having declared it to the State considers it necessary. Antigenic tests are authorities. not intended for close contacts of confirmed cases. Doctors, state-certified nurses, physiotherapists, midwives, dentists and pharmacists can perform antigen tests in their practice, at the patient's home, in pharmacies or in temporary gazebos. Rapid antigen tests are used as part of targeted screening when there is a risk of increased transmission (e.g. LTCF, high schools and universities, factories, collective accommodation, etc.). Patients admitted urgently to a health establishment, to make the right management decisions (for

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Table C.1 International strategies for the detection of current infection with SARS-CoV-2 (extracted on 16 April 2021) Country Testing strategy Expanded use of testing (e.g., Use of rapid or near-patient testing (for Population-wide testing screening) the detection of current infection) hospitalisation after going to the emergency room, for example). POC antigen testing is recommended but in more restrictive circumstances, such as for epidemiological studies, patients suspected of COVID infection but far from biological laboratories (e.g. in isolated rural areas, marginalised populations, great precariousness, migrants, etc.) and staff of certain institutions. All positive rapid test results must be followed up with a PCR test. Germany(66, 1. Symptomatic individuals Serial screening staff at a wide Staff at all health and social care facilities No population wide testing underway, 107, 159-161) 2. Asymptomatic persons in range of health and social care without a COVID case or residents, however, there is wide access and health care, other vulnerable settings (PCR or antigen). carers, patients, possibly visitors and all availability of antigen testing by areas and with contact Screening before (re)admission to staff at facility with a confirmed case, request of asymptomatic individuals or persons (with criteria of hospital, LTCFs, and other care only when PCR is not available. though participation in community exposure or disposition) facilities without a confirmed case Weekly random testing of inpatients, screening programs. 3. Priority is given to (PCR preferred). residents and those in care in inpatient vulnerable groups and their Random screening of residents and and outpatient settings, and for each carers, HCWs, and specific patients hospitals, LTCFs, and other visitor to inpatient and LTCF settings close contacts. care facilities without a confirmed (excluding RCFs). In addition, a free antigen test case (antigen), especially in the Contact persons only when PCR is not can be requested by an case of an increased regional available or there is an urgency and only asymptomatic citizen, incidence. for use in people for whom a false maximum once every week. Screening of visitors to hospitals, negative result does not lead to serious rehabilitation facilities, inpatient consequences (e.g., an undetected entry care facilities and facilities for of an infection upon admission to a people with disabilities without a hospital). case (antigen). Self-tests for staff and pupils in schools / Screening of staff at medical day-care centres and companies, one per practices, dental practices, practices week. of other medical health professions All asymptomatic citizens will be offered a and emergency services without a free rapid test at least once a week. confirmed case (antigen). All positive results must be followed up Screening of all service users, staff with PCR test. Before using the rapid and possibly all visitors at antigen test, it is recommended that the

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Table C.1 International strategies for the detection of current infection with SARS-CoV-2 (extracted on 16 April 2021) Country Testing strategy Expanded use of testing (e.g., Use of rapid or near-patient testing (for Population-wide testing screening) the detection of current infection) processing and reporting undertaken by an individual who has completed competency-based training. All positive RADT tests should be referred for confirmatory RT-PCR. Italy(74, 90, 115, Regions and autonomous Vulnerable patients, residents and Screening in hospitals, LTCFs, schools None underway. 164) provinces are responsible for staff in high-risk healthcare settings. and airports is permitted. their own approach to testing A wide range of settings are now People with symptoms or close contact of Provincial-level screening expanded to as per the "Relaunch Decree" permitted to implement screening a confirmed case with negative test result include voluntary targeted antigen 19 May 2020. However, the strategies including workplaces and followed up with PCR or non-rapid testing of randomly selected Ministry for Health issues schools. antigenic tests (laboratory), rapid subgroups, once a week for four guidance which recommends antigenic tests with fluorescence reading weeks, and representative of the testing symptomatic and those based on microfluidics with population of South Tyrol. individuals and close contacts fluorescence reading, which meet the Possibility that mass screening may be of confirmed cases. minimum sensitivity and specificity in use in other provinces; however, characteristics indicated (sensitivity unable to confirm. ≥80% and specificity ≥97%, with a more stringent sensitivity requirement (≥90%) in low incidence settings). For contact tracing (although PCR remains first line). Netherlands( Testing is provided to Admissions and discharge from a Symptomatic individuals in the following None underway. 68, 82, 86, 98, 165, symptomatic individuals, close healthcare setting. situations can be tested using antigen or 166) contacts and household Staff in key industries, sports LAMP (negative antigen result followed Large-scale testing pilots are being members of a confirmed case. participants and for attendance to up with PCR or LAMP): conducted with the aim to expand the Not all people who have events, and expanded testing to - Seriously ill people (vulnerable and non- programme to population-wide symptoms will be tested with include home sampling kits. vulnerable) who report to the healthcare screening on a monthly basis. No priority given for seriously ill, Pilots underway for field labs aimed system (e.g. GP, emergency care). further updates. specific patients in higher-risk at large events. - In institutions and for vulnerable groups and HCW who are Pilots underway for risk-based people. caring for vulnerable groups. voluntary testing in secondary - Not in institutions and for vulnerable education using self-tests and is people: antigen is possible in vulnerable currently being further elaborated persons with recent mild symptoms. on the basis of experience. The - Works with or is in contact with results will be available in early vulnerable people (care workers, informal May. carers, and visitors to institutions where vulnerable persons reside): Breath test possible (positive result must always be

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Table C.1 International strategies for the detection of current infection with SARS-CoV-2 (extracted on 16 April 2021) Country Testing strategy Expanded use of testing (e.g., Use of rapid or near-patient testing (for Population-wide testing screening) the detection of current infection) Regular screening in HCWs who test result followed up with PCR test in Conducting seroprevalence studies in provide direct health care and with situations of high clinical suspicion of samples of the population. a higher risk of contagion, COVID-19. appropriate to the context of each If the molecular test is not available or service / institution and according to does not allow the result to be obtained the level of exposure of in less than 12 hours, a rapid antigen test professionals, every 7 to 14 days. should be used. Periodic screening in schools, Rapid antigen tests preferred in an prisons, factories and civil outbreak situation (such as schools, construction (occupational contexts educational establishments, LTCFs of high social exposure) in the including RCFs and similar or closed municipalities with a 14 day institutions). cumulative incidence of Covid-19 Rapid antigen for occupational contexts cases of over 120 per 100 thousand of high social exposure. inhabitants, three times with 7 days Self-tests for the general public. apart. Self-tests are available for any asymptomatic people aged 18 years or over who requests one at in health care units, pharmacies and authorized non-prescription drug sales outlets. Inconclusive or positive result automatically followed up with a PCR test. Spain(169, 170) Any person with suspected Screening of asymptomatic Rapid antigen tests approved for The National Strategy does contain SARS-CoV-2 infection should individuals is permitted in certain widespread use. Test must have considerations for population-wide receive a diagnostic test for circumstances (e.g., workers or sensitivity >80% and specificity > 97%, testing. However, the autonomous active SARS-CoV-2 infection in inpatients/residents in healthcare must meet WHO criteria and have nature of various regions in Spain the first 24 hours. and LTCF settings; new admissions undergone independent validation makes a nation-wide screening The type of test (PCR or to health or social health centres; studies. programme unlikely. Antigen) used depends on a population subgroup Epi studies). Negative Transcription-Mediated number of criteria: disease PCR is preferred (pooled if Amplification (TMA) test result, within 72 Ongoing studies as part of the severity; availability of possible). hours of arrival, is acceptable in absence National Study of SARS-CoV2 resources; speed at which the of negative PCR test result for inbound seroprevalence Epidemiology in Spain. results are needed. passengers from high-risk countries. Sweden(70, 79, Testing is provided to At admission and readmission to a Symptomatic patients, ≤ 5 days from None underway 112, 171-173) symptomatic individuals and RCF. In the event of a negative test symptom onset when there is a need for contacts. Prioritisation is given result, a new test is taken three to increased test capacity or quick result. Ongoing Epi PCR and seroprevalant

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Table C.1 International strategies for the detection of current infection with SARS-CoV-2 (extracted on 16 April 2021) Country Testing strategy Expanded use of testing (e.g., Use of rapid or near-patient testing (for Population-wide testing screening) the detection of current infection) to patients, persons with risk five days later. Screening workers in RCFs (PCR test is studies within the general population factors and persons in long- People with home care or home primarily recommended) and other health and within specific areas (regions and term care, health and medical health care are tested when they care settings, several times a week. municipalities). staff, personnel in other return home after a hospital stay or Screening in workplaces or in other socially important activities, short-term stay. environments with a high spread of and individuals in other All care and nursing staff, infection, several times a week. Examples relevant parts of society to regardless of type of employment, given include schools and other enable the return to work who work in special housing for the educational activities, certain activities in more quickly. elderly, are eligible for screening. the police and emergency services, Testing according to the The screening should take place at certain construction sites, restaurant sampling indication applies least once a week. kitchens and theatre and film regardless of vaccination Sentinel sampling in nursing homes productions. status, but current indications from patients with flu-like illness For contact tracing investigation and for may be adjusted as the state every week include COVID PCR test people who are not in need of hospital of knowledge about the and is reported to the Swedish care (e.g. primary care, outpatient or effectiveness of covid-19 Public Health Agency for analysis. RCF). vaccination develops. Targeted screening in connection All positive test results followed up by with an ongoing outbreak in a PCR test. workplace, school or within parts of LAMP and TMA are also authorised, a municipality. however, there use appears limited to Self-sampling prior to PCR analysis inbound international travellers, is currently applied in many regions. alongside a PCR test. Stockholm region offers tests for antibodies and tests for ongoing disease to all citizens. Several other regions are doing the same. England(57, 64, The two main testing Close contacts of confirmed cases Rapid lateral flow tests including home No population wide testing. However, 102, 116, 120, 174- strategies used are: (PCR only). test kits for: there is wide-spread access to testing: 177) 1. PCR tests (mainly for people Serial testing of NHS patient-facing Available for anyone who requests one. pharmacies and community test sites with symptoms) staff, RCF staff and other high risk Screening programmes including frontline and at educational, workplace and 2. rapid lateral flow tests (only care and supported living staff, staff and patients and residents in health community settings. for people with no symptoms) twice a week, and for residents, and social care (including RCFs) settings, Anyone can request a rapid once a week. large-scale community testing, schools, lateral flow test regardless For admissions, self-sampling PCR universities and workplaces symptoms. test 3 day before procedure. Aged People who share childcare or a support Focus is on symptomatic 11 and older. Or as soon as bubble with someone who attends or testing with priority to possible/practical following works at a school, college or nursery, vulnerable groups, staff and admission across all the pathways. twice a week is recommended. Primary

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Table C.1 International strategies for the detection of current infection with SARS-CoV-2 (extracted on 16 April 2021) Country Testing strategy Expanded use of testing (e.g., Use of rapid or near-patient testing (for Population-wide testing screening) the detection of current infection) England, Northern Ireland, Scotland and Wales (groups of 5 or household). Plans for rapid testing for specific one-off events. Antibody home test kit are available to staff aged 18 and over in adult social care settings. Northern PCR testing is provided for RCF with outbreak free status: test Screening programmes in HSC and No population wide testing Ireland(91, symptomatic individuals and all asymptomatic residents every 28 workplaces using Lateral Flow test. 178-181) close contacts via self- days and all asymptomatic staff Queen's University in Belfast conducted a sampling kits testing every 7 days. rapid Covid-19 testing programme for Screening of HSC staff. Currently students. All positive test results followed there is a pilot where selected HSC up with PCR test. staff are being asked to carry out twice weekly testing. Screening of workers in key sectors and cohort pooled testing of university students. Antibody home test kit are available to staff aged 18 and over in adult social care, domiciliary care home care and primary care settings. Scotland(69, Scotland's Testing Strategy All close contacts (PCR). Lateral flow testing for: No population wide testing. However, 71, 87, 92, 93, 182, prioritises: Serial testing of all staff members in RCF staff twice weekly alongside PCR wide spread testing is being conducted 183) 1. testing to diagnose anyone patient-facing roles who work in testing (enhanced testing), visiting including educational and some with symptoms of COVID-19 NHS Scotland hospitals, the Scottish professionals to RCFs and outbreak workforce settings as well as targeted (PCR). No testing is Ambulance Service and other management staff testing if advised by community testing and expansion is undertaken after day 5 of emergency services control rooms, health protection. planned. In addition, waste water is coronavirus symptoms COVID-19 Assessment Centres, Serial testing in a wide range of being monitored across Scotland (200 appearing, unless agreed on a COVID-19 Vaccinators, Community educational and workplace settings and samples per week) and there are plans case by case basis by local Workforce and District Nurses, all populations using lateral flow testing for national antibody surveillance. microbiologists. patient-facing primary care workers including for designated visitors and 2. testing for clinical care of such as GPs, dentists, optometrists professional visitors to RCFs, fire services patients (Lumira DX POC test). and pharmacists, and all patient- Community testing on general population 3. testing to protect those facing staff who work in hospices, using lateral flow test. All those who vulnerable to the most harm twice weekly. receive a positive result with an LFD test from COVID-19. Screening of admissions and are advised to book a confirmatory PCR

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Table C.1 International strategies for the detection of current infection with SARS-CoV-2 (extracted on 16 April 2021) Country Testing strategy Expanded use of testing (e.g., Use of rapid or near-patient testing (for Population-wide testing screening) the detection of current infection) admission after 3-5 days should be considered. 2. Patient / resident in a Screening can be conducted in nursing home or other patients / residents in nursing healthcare institution homes or other healthcare 3. Employee in the healthcare institutions. service with work that puts Screening can be conducted in them in the vicinity of patients healthcare sector employees who 4. Person in a risk group, see work in the vicinity of patients. risk groups and their relatives Serial screening of students and 5. People who have been staff at schools, workplaces, and exposed to infection universities / colleges, in areas with 6. Other people with high infection pressure. symptoms Option to screen people moving into B) People without symptoms particularly dense living or work who have been exposed to environments with a high risk of infection: infection, e.g. arrival centres, 1. Outbreak situations in military camps, slaughterhouses and healthcare institutions prisons. 2. A close contact to a Targeted mass testing in an entire confirmed case of COVID-19 region, district or neighbourhood as 3. Healthcare personnel with a single event. patient contact who has been abroad C) Others Finland(73, 80, The national strategy Screening all residents and staff in Rapid tests will utilised increasingly in the No population wide testing. 113, 189-191) prioritised: RCFs should be considered when a testing effort to the extent possible. -prevent the spread of the case has been confirmed on the unit In epidemiological situations or in certain disease, protect at-risk groups until new cases no longer occur. target groups with a high incidence (> and ensure the adequacy of The test can be repeated, for 10%) of coronavirus infections (for critical staff and the carrying example, once a week. example in care and nursing units for the capacity of healthcare When testing capacity is available: elderly), the use of antigen tests may -enables efficient tracing of -social and health services, also be considered for testing infection chains reception centres, prisons and other asymptomatic individuals. -to create the most accurate institutions, as well as various work In low-prevalence areas and target possible picture of the course and other communities where close groups, antigen tests can be used for the of the epidemic. contact cannot be avoided: all early identification of coronavirus persons are tested after a low- infections in situations where: threshold corona case; -PCR testing capacity is not readily and

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