1. Preventing transmission
The section on PREVENTING TRANSMISSION includes information on key public health measures that aim to prevent the further spread of the disease. It details how countries are advising the general public and people who (might) have the disease to prevent further spread, as well as measures in place to test and identify cases, trace contacts, and monitor the scale of the outbreak.
1.1 Health communication
Physical distancing measures (“stay at home”) are mandatory in the timelines determined by the Albanian authorities, subject to change as the situation evolves. All non-essential work has been requested to be performed from home.
On 8 March 2020, the Minister of Health and Social Protection issued the Order No. 132: "On the closure of public and non-public activities and the cancellation of mass gatherings in closed or open places" until April 3”. This order was extended until the end of the COVID-19 epidemic via Order No. 222, issued on 1 April 2020.
All public and private institutions were asked to draft a plan of measures by 11 March, to ensure the provision of priority services, with a focus on the provision of online services or remote work, and only in necessary cases to provide services through physical contact. For services that require direct contact with the public, institutions were asked to provide employees with protective equipment. Public institutions were ordered to take measures to use online services and the e-Albania platform. The postal service was asked to guarantee continuity of the service and to draw up a plan of action to limit employee contacts with the public and to avoid congestion at counters or other indoor environments (Order No. 156 of the Minister of Health and Social Protection of 10 March 2020: “On special measures to prevent the spread of COVID infection - 19”).
Effective on March 11th, the lockdown started on Fridays at 17:00 until Monday at 05:00. All markets, pharmacies etc. remained closed during Saturday and Sunday. Only emergency movements were allowed and the police should be informed by citizens in advance through calls at 112/129. From Monday at 05:00 to Friday at 17:00, only one family member was authorized to go out for 90 minutes, ending at 17:30, following a pre-defined procedure to get permission at e-Albania (https://e-albania.al/) or by sending an SMS to telephone number 55155. Older people (women older than 60 years and men older than 65 years) were not allowed to go out. A minimum distance of 1.5 metres to other persons should be observed. The movement to and from work was allowed between 05:00 and 08:00 and between 16:00 and 17:30 (Order No. 259 of the Minister of Health and Social Protection of 10 April 2020: “For some additions and changes to Order No. 193 of 20 March For the closure and the restriction of the movement in the Republic of Albania”).
All bars, restaurants, fast food outlets and hotels etc. were ordered to remain closed until the end of the epidemic caused by COVID-19.
With regard to public and private transport, Order No. 168/1 of the Minister of Health and Social Protection of 15 March 2020: “On restrictions within the country”, stipulates the prohibition of movement by public and private means of transport of urban, intercity and suburban passengers until further notice. Exceptions to this rule were the means of transport specially authorized by the competent authorities and the transport of employees in public or private institutions who were allowed to commute to and from work in the time between 05:00 and 08:00 and between 16:00 and 17:30.
All educational institutions at all levels were closed in line with the Order No. 216 of the Minister of Health and Social Protection of 1 April 2020, which is an amendment to Order No. 190 of 19 March 2020: "On the closure of the activity of public and non-public educational institutions and kindergartens to limit the spread of COVID infection - 19".
All religious, cultural and sports gatherings are banned (Reference: Order No. 156 of the Minister of Health and Social Protection of 10 March 2020: “On special measures to prevent the spread of COVID infection - 19”, amended by Order No. 223 of 1 April 2020).
Movement in parks and green areas has been restricted, with gatherings confined to a maximum of 2 people, who have been obliged to remain at least two metres apart (Order No. 177 of the Minister of Health and Social Protection of 15 March 2020: “On the closure or restriction of movements in parks and green areas”).
With regard to specially confined populations (e.g. in long-term care facilities, psychiatric institutions, prisons), visits from relatives and friends are suspended or prohibited. Only in specific cases may visits be allowed, subject to approval by the director of the institution. Additional hygienic and sanitary measures are mandatory (Order No. 157 of the Minister of Health and Social Protection of 10 March 2020: "On measures to prevent COVID infection - 19 of the beneficiaries of social care services").
Measures taken in prisons include: ensuring medical care for people suffering from chronic diseases; the provision of personal protective equipment (PPE) for prison personnel and undertaking other preventive measures; and the suspension of meetings with the families of convicts until the situation stabilizes, substituting them with online communication.
The Government issued a Normative Act (on 23 March 2020) to quarantine in their homes for a period of 3 months all those persons convicted by a final court decision who by the date of entry into force of the normative act had 3 years of imprisonment left. The same applies to all those persons convicted by a final court decision who on the date of entry into force of the normative act had still 5 years of imprisonment left, but who were 60 years and over and suffering from chronic diseases which makes them more vulnerable to the COVID-19 virus, as evidenced by relevant medical documents. Both of these categories benefit from the Normative Act only if they have not been convicted of high-risk offences.
Normative Act No. 3 of 15 March 2020 “On special administrative measures during the COVID-19 infection period”, stipulates the following for non-compliance with social protection and lock-down provisions:
1. Entities or individuals organizing public and non-public activities, such as sports, cultural activities and conference, or mass gatherings indoors or outdoors, such as concerts, gatherings and public hearings, shall be fined up to ALL 5 million and the activity itself will be banned.
2. Access of patients' companions and/or family members to emergency medical facilities, health care facilities, hospital service facilities where patients are receiving inpatient treatment is banned, unless such a request comes from the Hospital Directorate. In case of such offence, patient's companion and /or family member and the person responsible for the implementation of this rule shall be fined in the amount of ALL 500,000.
3. A fine of ALL 700,000 shall be imposed on:
a. Citizens who enter the territory of the Republic of Albania and do not declare their arrival from areas affected by COVID-19 infection, as declared by the competent authorities, domestic or foreign or international;
b. Citizens, who enter the territory of the Republic of Albania from areas affected by COVID-19 infection, who are not self-quarantined for a period of 14 days in the premises of their apartment, as a preventive measure for preventing the spread of infection caused by COVID-19;
c. Citizens coming from affected areas and failing to comply with orders issued by the competent authorities for compulsory self-quarantine;
d. Citizens who have been tested positive and do not comply with orders given by the competent authorities for compulsory self-quarantine.
4. Educational institutions, creches and kindergartens (public and non-public) which do not close their activity for the period specified by the competent authorities, shall be punished by a fine of up to ALL 5 million (educational institutions), and up to ALL 1 million (creches and kindergartens). In case of a repeat offence, their activity shall be suspended for a period of 6 months.
5. Subjects or individuals, public or private, conducting activities in indoor recreation facilities for children and young people – such as gyms, sports centres, swimming pools, internet centres or cultural centres – which do not comply with the order of the competent authority for their closure, shall be punished by a fine of up to ALL 1 million, and in the event of a repeat offence, their activity shall be suspended for a period of six months.
6. Entities or individuals who fail to comply with orders issued by the competent authorities for the closure of bars, premises, restaurants and clubs shall be punished by a fine of up to ALL 1 million and in the event of a repeat offence, their activity shall be suspended for a period of six months.
7. Entities and individuals, public or private, who, contrary to the orders of the competent authorities, allow the development of sports, social, cultural activities, educational excursions organized by educational institutions, public and private, in the country or abroad, shall be fined to the amount of ALL 1 million and in case of a repeat offence, their activity shall be suspended for a period of six months.
8. The postal service authorities shall ensure continuity of the service and develop a plan of measures to limit employees’ contact with the public and public crowding. Failure to comply with this obligation shall be punished by a fine of ALL 1 million and, in the event of a repeat offence, their activity shall be suspended for a period of six months.
9. Immediate measures should be taken to stop the crowding of patients in indoor or special structures of health care institutions, polyclinics, hospitals – both public and non-public – where outpatient visits and consultations are conducted. Failure to comply with this obligation shall be punished by a fine of up to ALL 1 million and, in the event of a repeat offence, their activity shall be suspended for a period of six months.
10. Drivers who fail to comply with the prohibition of public and private transport in areas and schedules designated by the competent authorities shall be punished by revocation of their driving license for a period of three years and by the seizure of their vehicle. This rule excludes persons authorized by the competent authorities.
11. All audiovisual broadcasts with more than two persons in the same television studio shall be punished by a fine of ALL 1 million and, in the event of a repeat offence, the penalty includes the partial or complete blocking of media broadcasting as well as the blocking or stopping of the operation of the equipment, after a decision is taken by the Ministry responsible for Health and implemented by the competent body.
12. Failure to provide services by pharmacies, wholesalers and medicine manufacturers, by applying the safety criteria set by the competent authorities, shall be punished by a fine of ALL 10 million to wholesalers and ALL 50,000 to retailers. In case of a repeat offence, blocking the whole quantity of goods and closure of the activity for a period of three years shall be imposed.
13. Failure to provide services by entities / individuals trading foodstuffs, wholesalers or retailers, by applying the security criteria set by the competent authorities, shall be punished by a fine of ALL 10 million to wholesalers and ALL 50,000 for retailers. In case of a repeat offence, blocking the whole quantity of goods and closure of the activity for a period of three years shall be imposed.
Restrictions on the movement of people were eased successively from the 20 April (see “Transition measures for the gradual opening of the economy, Measures in other sectors”). However, as of the 11 November the movement of people and vehicles from 22:00 until 06:00 each day has been banned, as well as the closing of bars/restaurants during this time. Everyone who will need to go out during this time for work or other important reasons must obtain permission to go out by applying at the e-Albania platform. The approval is sent via email to one’s account or SMS to one’s registered mobile number at e-Albania. Anyone breaking the curfew risk being fined (reference: Order of Minister of Health and Social Protection No. 615, dated 9.11.2020; Order of Minister of Health and Social Protection No. 616, dated 9.11.2020).
In addition, from the 17 November gatherings of more than 10 people in open and closed areas have been forbidden. This includes political meetings and rallies, conferences, festivities, wedding ceremonies and funeral ceremonies beyond family members (reference: Order of Minister of Health and Social Protection No. 633, dated 17.11.2020).
From 24 Dec 2020 until 04 Jan 2021, the movement of people in the timeframe 20:30hrs until 06:00hrs is prohibited, except for essential or work-related reasons. The permission can be obtained through the e-Albania platform.
Bars and restaurants will be closed between 20:30hrs and 06:00hrs, from 24 Dec 2020 until 04 Jan 2021, except for delivery services.
On 05 Jan 2021, the restrictions in movement and activities of bars and restaurants will return to 22:00hrs until 06:00hrs.
(Reference: Order of the Minister of Health and Social Protection, No.680, 21 December 2020).
Official advice on hand hygiene, respiratory etiquette, and physical distancing was issued through Order No. 81 of the Minister of Health and Social Protection on 10 February 2020: “For the approval of protocols and algorithms for the prevention of COVID-19 in the country”, and Order No. 105 of the Minister of Health and Social Protection of 24 February 2020: “On hygienic and sanitary measures to prevent the spread of acute respiratory infections, including COVID - 19 in pre-school institutions, kindergartens, nurseries and other educational institutions”.
The public communication of this official advice intensified after confirmation of the first two positive COVID-19 cases on 8 March 2020.
Information on outbreak severity and responses is being conveyed to the public on a daily basis by the Ministry of Health and Social Protection (https://new.shendetesia.gov.al/), technically supported by the National Institute of Public Health (http://www.ishp.gov.al/).
Information on response measures is being conveyed to the public on a daily basis by the Prime Minister (https://kryeministria.al/en/).
The WHO case definition (https://www.who.int/docs/default-source/coronaviruse/2020-03-20-surveillance.pdf?sfvrsn=e6be6ef1_2) has been adopted.
Moderate and severe affected cases are admitted to designated hospitals: the Infectious Diseases Service at the University Hospital Centre “Mother Tereza”, named Hospital COVID 1, and the University Hospital “Shefqet Nroqi”, named Hospital COVID 2. The transportation of cases is done through the designated ambulances of the National Medical Emergency Service.
Mild affected cases are asked to self-isolate at home and be in regular contact through telephone with their Family Doctor and call the Emergency Medical Service in case of any deterioration.
Order No. 81 of the Minister of Health and Social Protection of 10 February 2020 "On the approval of protocols and algorithms for the prevention of COVID-19 disease in the country"
Order No. 122 of the Minister of Health and Social Protection of 26 February 2020 "On the approval of protocols and measures against COVID-19, to be implemented by the National Emergency Medical Centre"
All citizens who enter the territory of the Republic of Albania from areas affected by COVID-19 are obliged to be self-quarantined for a period of 14 days in the premises of their apartment, as a preventive measure for preventing the spread of infection.
A special facility has been adapted for COVID-19 quarantine (Order No. 53/2 of the Minister of Health and Social Protection of 26 February 2020 "On the establishment and operation of the quarantine service in designated facilities and Decision of the Council of Ministers No. 204 of 9 March 2020 "On measures for the establishment of infrastructure for the quarantine service and for an additional fund in the approved budget of the Ministry of Defense").
Albanian citizens who are repatriated are requested to be quarantined for 14 days in designated facilities (hotels). The cost of accommodation is co-shared.
All other suspected cases and contacts are requested to self-quarantine in their houses/apartments for 14 days, as advised by the surveillance teams.
Restrictions on the movement of people have been eased successively since 20 April (see “Transition measures for the gradual opening of the economy, Measures in other sectors”).
In Albania, the WHO definition of COVID-19 (https://www.who.int/docs/default-source/coronaviruse/2020-03-20-surveillance.pdf?sfvrsn=e6be6ef1_2) is used with regard to suspect cases, probable cases, confirmed cases and contacts.
Contact tracing is implemented by surveillance teams in all 12 regions of the country.
The surveillance of COVID-19 is built on the pre-existing respiratory disease surveillance systems:
• the syndromic surveillance system for acute respiratory infections (ILI);
• the hospital-based surveillance of severe acute respiratory infections (SARI);
• the laboratory surveillance system.
A ministerial order was issued to enforce the notification of COVID-19 related cases/probable cases/suspect cases by all health institutions in the country (Order No. 123 of the Minister of Health and Social Protection of 26 February 2020, created as an addition to the existing Order no. 632 dated 29 August 2018: "On the approval of the list of obligatory infectious diseases to be reported by health, public or private institutions of all levels in the Republic of Albania").
Suspect cases (according to the WHO definition) are being tested for COVID-19. Contacts are being tested only in certain situations as indicated by local risk assessments.
Testing is initiated by the surveillance teams or the Emergency Medical Service.
COVID-19 testing occurs at the Virology Laboratory of the National Institute of Public Health in Tirana. The Virology Laboratory of the National Institute of Public Health has two PCR machines: Model ABI 7500 and Model ABI 7500 Fast, Applied Biosystems. This capacity is being used.
The average number of tests per day is approximately 250.
Capacities that are currently unused but will be available soon include:
• a PCR machine at the University Hospital Centre “Mother Tereza”, Tirana, Albania: Exicycler Exiprep AccuPower SARS CoV2 real-time PCR. The procurement of testing kits is pending.
• 2 GeneXpert machines (4 modules each) at the University Hospital “Shefqet Ndroqi”. The procurement of testing kits is pending.
As of 16 July 2020, the testing capacity in Albania was approximately 400 tests per day, which corresponds to an estimated 1 test per 1000 population per week or 10,583 tests per 1 million population. Sample positivity is up to 23%.
As of 23 July, permission may now be granted for non-public (private) laboratories to conduct RT-PCR tests for SARS-COV-2 for administrative purposes (Order no. 437, dated 23.07.2020 of the Minister of Health and Social Protection). The criteria to be met by non-public structures to perform the RT-PCR test are outlined in the following guidance: https://shendetesia.gov.al/wp-content/uploads/2020/07/Scanned-Documents.pdf