Policy responses for Czech Republic - HSRM

Czech Republic


Policy responses for Czech Republic

5. Governance

5.1 Governance

The GOVERNANCE of the health system with regard to COVID-19 relates to pandemic response plans and the steering of the health system to ensure its continued functioning. It includes emergency response mechanisms, as well as how information is being communicated, and the regulation of health service provision to patients affected by the virus.

In January, the state of emergency was prolonged for the fourth time, until February 14, 2021. Visits to hospitals were newly allowed as of January 11 under strict conditions (at least FFP2 face covering and a negative test) and for a maximum time of 30 minutes, applicable for two persons at the same time, once a day per a patient [14], but prohibited again on January 30.

As of January, the PES risk scores also incorporated results of antigen testing (previously, only PCR tests were used in calculating the PES). The risk score calculation developed over the past weeks substantially. The number of newly detected cases per 100 000 population in last 14 days, the same indicator for the senior population, and the reproductive number are taken into account. Instead of test positivity rate, weekly share average of inpatient patients for whom COVID-19 was detected only during their inpatient stay has taken into account since January 5. Starting on February 1, the number of COVID-19 patients in hospitals is incorporated into the risk score calculation as well. As the Minister of Health stated, level 4 will not be declared unless there are less than 3 000 COVID-19 patients in hospitals (in late January there were around 6 000 people in hospitals with COVID-19).   

The vaccination strategy and related communication strategy are the responsibilities of the National Vaccination Coordinator at the MoH. The first coordinator, the former head of State Institute for Drug Control, resigned on January 25 after only two months in office. The new coordinator is an MoH office and head of international affairs department. 

On February 14, because parliament did not approve a sixth extension, the state of emergency ended after 136 days. The opposition parties argued that the government had not given valid explanations as to why a state of emergency declaration was still needed (i.e. for which particular measures), and that the Anti-Pandemic Act that the government had promised to introduce in autumn (replacing the need for a formal state of emergency to combat COVID-19) had not been presented to parliament. The Communist party, who had previously voted with the government on this matter, joined other opposition parties to vote against extending the state of emergency. This happened at the same time that the epidemiological situation was rapidly deteriorating, and so the state acted to delegate its main responsibilities for handling the pandemic (including running the regional hospitals) to regional governments. Thus, regional governors exercised their right (according to the Czech Republic Safety Act) to formally request the government to declare a new state of emergency. The government complied, and so the state of emergency was actually not interrupted, though constitutional lawyers and many politicians opposed this as an unconstitutional action. As a result, a new state of emergency was declared to start right after the previous one expired on February 27. This new measure did garner some support from parliamentary parties, though it came with the caveat that the government was forced to actually discuss anti-pandemic measures with opposition parties for the first time since the original outbreak in March 2020.

Regional governors conditioned their support for helping the government declare a new state of emergency by outlining several areas for action:
1) That parliament adopt the new Anti-Pandemic Act, allowing the country to combat the pandemic without the necessity of imposing states of emergency (see below);
2) A gradual reopening of schools from March 1 coupled with regular student testing (tests were purchased, but schools remained closed, including shuttering the 1st and 2nd grades of elementary schools and all preschools that had been open, due to yet worsening epidemic situation – see section 1.2 Physical distancing);
3) The introduction of regular POC antigen testing in companies within 14 days (implemented in March, see section 1.5 Testing);
4) An extension of opening hours for public services (began on February 15);
5) An end to night curfew (this was not implemented – night curfew continued);
6) The reopening of small retail stores (was assured for February 22), which did not happen.

The Anti-Pandemic Act was approved by parliament just days later on February 18. It allows the MoH to restrict retail and services, manufacturers, swimming pools, public and private events and gatherings, regionally and nationwide, without having to declare a state of emergency. The Act also deals with compensation of businesses affected by the measures. The measures would be introduced in parliament and would require proper debate. However, it was not used in March (as planned) due to an even worse epidemiological situation that required additional restrictions on free movement. The new Act does not allow for movement restrictions, whereas the state of emergency does.

The current state of emergency has been approved until March 28 and then prolonged, with the Parliament consent, until April 11.

In mid-March, the Chief Public Health Officer was dismissed without reason and despite opposition of Regional Public Health Authority heads. Prime Minister Babiš later said that it was due to a need for higher media visibility. The newly appointed Chief Public Health Officer, the former head of the Moravskoslezský Regional Public Health Authority, was tasked with preparing a new PES risk scoring system. The government had ceased using the PES score to determine lockdown measures in February and March, declaring instead that the only determining indicators for restrictions were the number of hospitalized COVID-19 patients and the number of patients requiring intensive care. The new PES risk scoring system should also feature criteria for restriction loosening.
  
There have been calls since January 2021 to introduce full earnings compensation for those who are quarantined (the current sick leave allowance is limited to 60% of an employee’s average earnings, with the self-employed generally not being covered). After reluctance from the government and difficulties in agreeing on the exact form of compensation, a special compensation (on top of the standard sick leave allowance) of up to CZK 370 per day for quarantined and isolated employees was approved, in force for March and April 2021 (9); the self-employed are newly entitled to quarantine/isolation allowance of CZK 500 per day (see Section 1.5 for more).
There have been calls since January 2021 for the introduction of full earnings compensation for those who are quarantined to solve this issue (current sick leave allowance is limited to 60% of employee’s average earnings, with the self-employed generally not being covered). After government reluctance and difficulties in agreeing on the exact form of compensation, a special compensation scheme (on top of the standard sick leave allowance) of up to CZK 370 (EUR 14) per day for quarantined and isolated employees was put in place for March and April 2021 (9) with the self-employed being entitled to an allowance of CZK 500 per day (EUR 19) (see Section 1.5 for more detail).

Sources:
[1] https://ppo.mzcr.cz/workGroup/91
[2] https://www.mzcr.cz/verejne/dokumenty/pandemicky-plan-ceske-republiky_5520_5.html
[3] https://www.mzcr.cz/dokumenty/na-ministerstvu-zdravotnictvi-zasedla-kvuli-koronaviru-ustredni-epidemiologicka-_18596_1.html
[4] https://cs.wikipedia.org/wiki/%C3%9Ast%C5%99edn%C3%AD_epidemiologick%C3%A1_komise
[5] https://www.mvcr.cz/mvcren/article/ustredni-krizovy-stab-uks.aspx
[6] https://ct24.ceskatelevize.cz/domaci/3069180-ustredni-krizovy-stab-mel-prevzit-hamacek-prymula-se-chce-soustredit-na-organizaci
[7]. https://www.vlada.cz/cz/epidemie-koronaviru/dulezite-informace/vlada-zrychlila-scenar-uvolnovani-mimoradnych-opatreni--od-pondeli-mohou-otevrit-vetsi-provozovny-181185/
[8] Ministry of Health website, accessed April 20, https://koronavirus.mzcr.cz/uvolnovani-opatreni/      
[9] https://www.vzp.cz/o-nas/aktuality/postupne-rusime-nouzova-organizacni-opatreni
[10] https://www.ceskenoviny.cz/zpravy/ustredni-krizovy-stab-dnes-ukoncil-cinnost-rekl-hamacek/1901057
[11] Ministry of Health Extraordinary Measure No. MZDR 27737/2020-1/MIN/KAN, issued on July 3, 2020
[12] Government Resolution No. 813 from July 27, 2020
[13] https://koronavirus.mzcr.cz/wp-content/uploads/2020/11/PES_matice_opatreni_221120_final.png
[14] https://apps.odok.cz/attachment/-/down/RCIABX2HRQ9T

The Central Epidemiology Committee restored its operation on September 18 upon calls to do so (mainly from the opposition parties’ and regional council presidents).

When Central Crisis Staff (CCS) activity was being reduced prior to its deactivation in June, the Governmental Committee for Health Risks has been established in the meantime as a new advisory body to the government. Its working body is the Integrated Central Management Team (Integrovaný centrální řídící tým, ICŘT) led by the Chief Public Health Officer, with permanent members from the MoH (2 other representatives) and Army (2 representatives), and various temporary members [12].
 
In early September, the Prime Minister declared that there was no need to activate the CCS again because many things were being operated by this new advisory body. Opposition parties and the minor coalition party called for reactivation of the CCS due to the rapidly increasing number of cases. On September 21, the Minister of Health, Adam Vojtěch, resigned. Mr. Prymula, the head of the Governmental Committee for Health Risks, was appointed as new Minister of Health, and the CCS was reactivated, chaired by the Minister of Interior, Mr. Hamáček.

The state of emergency was declared on October 5 and then prolonged till November 20 and subsequently four more times until February 14, 2021.

On October 19, the National Inpatient Care Dispatching restored 24/24 operation. Inpatient facilities report any change in their ICU beds capacity and occupancy daily. The coordination across regional governments and inpatient facilities in regions is aligned with the central level through Regional Intensive Care Coordinators (usually chief physicians of main regional hospitals’ departments of anaesthesiology and resuscitation) who cooperate with National Intensive Care Coordinator. There is also a National Coordinator for Testing, leading the MoH’s Laboratory Expert Committee (see section 1.4).

In late October, the government decided to invest CZK 50mil in an information campaign to promote restrictive measures observance among people.

In late October, another change on the Health Minister post happened after Mr. Prymula was caught leaving a restaurant without wearing a mask, even though restaurants were not allowed to open at that moment. On October 29, Mr. Blatný, a child haematologist and vice-director of a university hospital, was appointed Minister of Health.  

On November 13, the MoH presented the new Antipandemic System – called PES (ProtiEpidemický Systém), meaning “dog” in Czech. It has 5 levels, assessing the risk of infection transmission on a scale from 0 to 100. The assessment is done based on 14-day average number of new cases, new cases with seniors, the R0 number, and test positivity rate, among others. The system shall provide district-level assessment of risks and associated restrictive measures. The table (in Czech) is provided on the official governmental webpage [13].

Nevertheless, the system clearly states that releasing the restrictive measures is a longer process when numbers must prove to stay low. As of November 16, the whole country was in the highest (5 - purple) level, though the November 13 risk score was 70, i.e. falling within the level 4. On November 23, the official level 4 was declared for the whole Czech Republic, resulting in shorter night curfew (11pm+ instead of 9pm+) and gatherings of 6 people (instead of 2) allowed. Using the PES system, the levels from the level 3 shall be declared for the whole country, whereas when the transmission risk decreases to levels 1 and 2, these shall be declared region-based.

By the end of November, the PES risk scores varied substantially among regions, with some regions scoring on the 4th level. Still, the PES level 3 was declared since December 3 resulting in more loosening of physical distancing restriction since then: gatherings outdoors up to 50 people, indoors 10; reopening of restaurants (closed 10pm-6am) for max 4 people at a table; reopening of hotels also for non-business trips; reopening of stores and shopping centres under strict regime (1 customer per 15m2, 2m distance, queues’ management indoor and outdoor); funerals and weddings up to 30; no restrictions of free movement and no night curfew. Specifications of restriction measures in different PES levels was published for production and retail and for sports.

After only being allowed to reopen for six days, restaurants were forced to shorter opening hours (closing at 8pm) on December 9. Alcohol take-away selling and consumption of alcohol outdoors on public places was once again prohibited.

On December 18, the PES level 4 was declared (while the PES score started to indicate the 5th level already). In terms of enforcing measures for the change in PES risk score, not all restrictions prescribed for the 4th level were in place this time: while restaurants (only take-away food allowed), hotels, and fitness studios all had to close, stores and services remained open, including on Sundays. Museums and galleries closed again (after only being reopen for 14 days). Churches were allowed to hold mass only with 20% of a church’s regular capacity, and Christmas school holidays were moved forward to already begin by Monday, December 21. A night curfew was imposed again, from 11pm-5am, and gatherings were again capped at only 6 people. Senior care homes visits were allowed with a negative test.

On the very same day as the risk score changed to a higher level, December 18, ski lifts in the country opened, though accommodation at ski sites was not permitted. Furthermore, new state support for restaurants and hotels was announced, but there have been complaints that it did not cover all costs.

The state of emergency was prolonged again on December 22, to January 20, 2021. Later, on December 27, the highest level 5 of the PES system was declared, and stricter preventive measures imposed: only gatherings of 2 people allowed; night curfew 9pm till 5am; all nonessential businesses and services ordered to close (including, for the first time, closing parts of supermarkets selling nonessentials); customer capacity in open stores limited to 1 person per 15m2; weddings and funerals limited to 15 persons; churches open for 10% of its seating capacity; ski resorts closed. Only elementary schools’ 1st and 2nd graders allowed to in-person schooling after Christmas holidays (Jan 4 on), all other students on remote schooling again. Visits to hospitals prohibited, visits to senior homes continue to be allowed with a negative test and with a face covering equivalent to at least FFP2 mask.

The national response to COVID-19 is led by the Ministry of Health (MoH; including the Chief Public Health Officer, who is a Deputy Minister of Health), the COVID-19 Central Management Team (chaired by another Deputy Minister of Health), and the Central Crises Staff. Each body has its own responsibilities (see below).

The Central Epidemiology Committee (Ústřední epidemiologická komise) [1], established in 2006, is a permanent working body of the government. The Committee is responsible for controlling, coordinating and steering public health protection, including the readiness of other ministries, in cases of incidences of severe infectious disease. It is chaired by the Minister of Health, and the Chief Public Health Officer is its vice-chairman. Its members include senior officers from the Ministries of Defence, Interior, Transport, Finance, Education, Industry, Regional Development, Agriculture, Foreign Affairs, as well as the vice-chairman of Administration of State Material Reserves and others. The Committee is responsible for drafting and updating the Czech Pandemic Plan (last updated in 2011) which focuses mainly on influenza [2]. The Committee holds meetings at least once a year. Due to the COVID-19 outbreak, the Minister of Health called the Committee for a meeting on February 27, 2020 to fulfil its [3]. When a State of Emergency is declared, the Central Epidemiology Committee becomes part of Central Crises Staff (see below) [4].
The Central Epidemiology Committee stopped meeting in May.

On March 12, 2020, the Government proclaimed a State of Emergency for 30 days in relation to the COVID-19 epidemic as pursuant to Articles 5 and 6 of the Constitutional Act No. 110/1998 Coll., on the Security of the Czech Republic. The declaration gave the Prime Minister authority to coordinate and lead the State of Emergency and authorized the government to issue resolutions in this regard and to inform the Parliament. The State of Emergency allows the government, among other things, to purchase goods and services without using standard public procurement procedures and to approve legislative proposals in a fast-track legislation process (State of Legislation Emergency). Any further extension of the State of Emergency can only be done with consent from the Parliament; the Parliament agreed to prolong the State of Emergency until the end of April 2020, and then again until May 17, 2020.

The government activated the Central Crisis Staff (CCS, Ústřední krizový štáb) on March 16, 2020. It is a working body of the government responsible for crisis management chaired by the Minister of Interior or Minister of Defence. The chairman of the CCS submits recommendations to the Security Council of the State and, if necessary, directly to the government [5].

The government changed the statute of the CCS’ in March, before the CCS activation. According to the new version of the statute, the Prime Minister is to appoint the CCS chairman from one of the government members or ministerial staff. At first, the Deputy Minister of Health (Mr. Prymula) was appointed. Thus, the CCS was activated only several days after the State of Emergency declaration, a fact that was heavily criticized by the opposition. Later, the Minister of Interior (Mr. Hamáček, head of another coalition part- Social Democrats Party) was appointed as the chairman of the CCS on March 30, replacing Mr. Prymula [6]. During the State of Emergency, the CCS plenary met once a week and the permanent working group met daily. Additionally, there were several other working groups responsible for specific issues. After the State of Emergency ended, the CCS continued its activities in a limited scope. The CCS was deactivated on June 11, 2020 [10].

The COVID-19 Central Management Team (Centrální řídící tým COVID-19) was established as an advisory entity to the government on March 30, 2020, on June 30, it was re-established as the MoH advisory body. It is tasked with implementing most of the government’s COVID-19 agenda, including the monitoring and coordination of testing and laboratory capacities [11], intensive care and lung ventilators capacities, and with the so-called “smart quarantine” system, a set of measures to ease tracking potential cases. The Central Management Team also recommends new measures and designated areas to limit spread of the virus.

During the State of Emergency, the government ruled via resolutions and the MoH has issued Extraordinary Measures based on the Act on Public Health Protection (No. 258/2000 Coll.), including after the conclusion of the State of Emergency. All resolutions and measures have been immediately published on websites of the government or respective ministries:
● Government of the Czech Republic website - https://www.vlada.cz/cz/media-centrum/aktualne/vyhlaseni-nouzoveho-stavu-180234/
● Ministry of Health website - https://www.mzcr.cz/obsah/aktualni-mimoradna-opatreni-a-rozhodnuti-ke-covid-19_4135_1.html, https://koronavirus.mzcr.cz/category/mimoradna-opatreni/
● Ministry of Labour and Social Affairs website - https://www.mpsv.cz/web/cz/informace-ke-koronaviru
● Ministry of Finance website - https://www.mfcr.cz/cs/aktualne/koronavirus-covid-19
● Ministry of Economy website - https://www.mpo.cz/cz/rozcestnik/pro-media/tiskove-zpravy/prehled-pomoci-podnikatelum-a-zivnostnikum--253649/

During the disease outbreak, the health insurance funds amended their regulations for health care providers, which were published on the websites of individual funds. For example https://www.vzp.cz/poskytovatele/informace-pro-praxi/covid-19. Most of the regulations, including specific payment methods, were called off by June 30 (for details, see section 4.2) [9].

By mid-April, the epidemic was contained (R0 decreased below 1) and the government was forced by political pressure to introduce the Restrictions Release Plan (RRP). This plan was updated a week later due to an improving epidemiological situation in which cancellation of some restrictions was accelerated [7]. Relaxing the restriction was divided into five phases, starting on April 20 [8]. Continuous monitoring remained in place and the containment of the virus (based on R0) was the main consideration for easing restrictions. Secondary criteria included other country experiences, financial and overall well-being of the population and SMEs and farmers negatively impacted by NPIs. Depending on R0, the interventions and timeline of the RRP was subject to change. Continuous evaluation on a 14-day basis continued (monitoring the R0 to stay below or close to 1; COVID-19 admissions and ICU occupancy). More details on the Restriction Release Plan of April 23, and its later updates are described in Transition measures: Governance.

The government also ordered a study to estimate how many people have been already in contact with the COVID-19 virus. For results see section 1.4 Monitoring and surveillance.

In late June and early July, clusters of infections emerged on several places: at first, few districts with new cases in the Moravskoslezsky region were detected. This led to reintroducing few locally applicable restrictive measures (wearing face masks indoors, in public transport, and in gatherings, gatherings limitation, restaurants’ opening hours restriction, banning visits to hospitals and LTC facilities except for terminally ill, minors, and mothers-to-be accompany, etc). On July 14, some of these measures (face masks wearing) were reintroduced also in the Jihlava district, though mayors complain the outbreak concerns only one particular town.


Sources:
[1] https://ppo.mzcr.cz/workGroup/91
[2] https://www.mzcr.cz/verejne/dokumenty/pandemicky-plan-ceske-republiky_5520_5.html
[3] https://www.mzcr.cz/dokumenty/na-ministerstvu-zdravotnictvi-zasedla-kvuli-koronaviru-ustredni-epidemiologicka-_18596_1.html
[4] https://cs.wikipedia.org/wiki/%C3%9Ast%C5%99edn%C3%AD_epidemiologick%C3%A1_komise
[5] https://www.mvcr.cz/mvcren/article/ustredni-krizovy-stab-uks.aspx
[6] https://ct24.ceskatelevize.cz/domaci/3069180-ustredni-krizovy-stab-mel-prevzit-hamacek-prymula-se-chce-soustredit-na-organizaci
[7]. https://www.vlada.cz/cz/epidemie-koronaviru/dulezite-informace/vlada-zrychlila-scenar-uvolnovani-mimoradnych-opatreni--od-pondeli-mohou-otevrit-vetsi-provozovny-181185/
[8] Ministry of Health website, accessed April 20, https://koronavirus.mzcr.cz/uvolnovani-opatreni/      
[9] https://www.vzp.cz/o-nas/aktuality/postupne-rusime-nouzova-organizacni-opatreni
[10] https://www.ceskenoviny.cz/zpravy/ustredni-krizovy-stab-dnes-ukoncil-cinnost-rekl-hamacek/1901057
[11] Ministry of Health Extraordinary Measure No. MZDR 27737/2020-1/MIN/KAN, issued on July 3, 2020
[12] Government Resolution No. 813 from July 27, 2020
[13] https://koronavirus.mzcr.cz/wp-content/uploads/2020/11/PES_matice_opatreni_221120_final.png
[14] https://apps.odok.cz/attachment/-/down/RCIABX2HRQ9T

On July 27, 2020, the MoH introduced a system of alert levels, the so-called traffic lights. For all 75 districts in the Czech Republic, the traffic lights identify 4 different levels of COVID-19 infection transmission, for which different preventive measures shall be introduced. The levels include 0, white (none or negligible risk of transmission), to 1, green (infection incidence without community transmission), 2, orange (beginning community transmission), and 3, red (increasing or persisting community transmission) (1). The official traffic light map of the country’s districts is updated weekly.

Each infection transmission level is associated with a set of preventive and public health surveillance measures, including: local crises staff and info lines activation, management of sample collection points and laboratory capacities, inpatient care patient entrance triage, acute care beds switch and designating COVID-19 patients’ medical personnel, introduction of face mask obligation, gathering limitations, restaurants’ opening hours limitations and social distancing measures.

In early August, the MoH declared that the obligation to cover mouth and nose in public places would only be associated  once a district’s traffic light turned orange. However, already  it was clear by the end of August that the traffic light system and its associated preventive measures was not strict enough: Prague turned “orange” on August 28, but the MoH announced the community transmission was “only starting” and an order requiring face masks in public was not issued. Later, the government introduced some “orange” measures nationally, while most districts were still green or white (restaurant closure hours 12pm-6am nationwide since September 18 , face masks required in common areas in schools , and then all places in school except 1-5th graders, for example).

August 28: Prague was the only orange district, while 4 other districts were green. Some districts also moved from green to the white level.
September 17: 11 orange districts, only 13 white, and the rest green.
With increasing infection spread, the traffic-light updating become more frequent:

September 18: Prague red, 10 orange districts, only few white, the rest green.

September 21: Prague red, 28 orange districts, the rest green (no white district).

This traffic light system was officially replaced by a new system called PES on November 13, see 'Governance' box in this section.

(1) https://www.mzcr.cz/wp-content/uploads/2020/07/Stupne-pohotovosti-v-oblasti-ochrany-verejneho-zdravi.pdf

A Restrictions Release Plan (RRP) was announced on April 23 and included the following categories [1]. Only a day later, on April 24, the government updated the plan and accelerated the RRP:    

• Schools:

From April 20, 2020
Universities (scientific and academic institutions) - individual activities within the framework of university studies for students in the last year of study and up to a maximum of 5 students in one activity were allowed to restart. Individual consultations; individual examinations, and in particular final examinations for those finishing their studies; as well as on-site presence in laboratory, experimental, artistic and practical activities and practices or clinical and practical instruction (which are necessary either for the completion of bachelor, master or doctoral studies or theses) were allowed once more. Individual visits to libraries and study rooms to lend or return study literature were also re-allowed.

From April 27, 2020
Activities for students in the last years of study on April 20 was permitted for all students.

From May 11, 2020
Secondary schools, secondary art schools and colleges were allowed to reopen- exclusively for final examination and graduation. Individual lessons at primary art schools and language schools resumed. Full-time teaching for children in housing facilities also resumed.

From May 25, 2020
Primary school students (grades 1-5) could voluntarily return to school and their organized and leisure activities in the form of school groups - recommended 15 children in a group (one child per table) and without the possibility of changing the group composition, while making  face masks in the common school areas compulsory. Teachers and students from risk groups could choose to stay at home, and continue with online courses. This option also applied to some types of special primary schools (visually impaired, pupils with speech disorders).

Neither primary schools nor secondary schools were open for mandatory participation until June 30, 2020. It was recommended to wear masks during the lessons and masks must be worn for all activities in close proximity, such as group work or walking in hallways. After school clubs or clubs combining multiple groups were not allowed; later this measure was applied to indoor activities only. Physical education was not allowed. Instruction at art schools, language schools giving state language examinations and lessons in leisure centres were allowed to a maximum of 5 children.

From June 8, 2020:
Primary school students of the grades 6-9 could return to schools for individual and group lessons (i.e. no mandatory participation, no daylong in-school learning)

• Businesses (as of April 24):

From April 20: Opening of shops such as craft and craft tools shops, outdoor farmers’ markets, car repairs and showrooms.

From April 27, 2020:
Shops up to 2 500 m2 could reopen as long as they were not in shopping centres over 5 000 m2, with exception for establishments with separate entrances from the outdoor area (did not apply to establishments that will be opened in the next stages, including restaurants, cafes, hairdressers, barbers, etc.). It was also possible to reduce the sales area to the required size by marking with tape.
Gyms and fitness centres without the use of showers and changing rooms could reopen under precisely defined conditions.
Drivers’ schools reopened (theory and other forms of teaching for up to 5 people).
Outdoors exhibitions such as zoos, botanical gardens and libraries were also allowed to open again.

From May 11, 2020:
All shops in shopping centres could reopen with the exception of premises with separate entrances from the outside (this does not apply to premises that will be opened in subsequent stages). Establishments not located in shopping centres and with areas above 2 500m2 could also open again.
Restaurants, pubs, cafeterias, cafes, wine shops, and pubs allowed to serve guests outdoors (summer gardens); sales through a dispensing window continued to be allowed.
Hairdressing, barbers, beauty salons, tanning salons, cosmetic shops, massage parlors were allowed to reopen.
Museums, galleries and exhibition halls in compliance with specified conditions were also allowed to reopen, as were castles, chateaux, outdoor museums.

From May 25, 2020:
Interior spaces of restaurants, pubs, cafeterias, cafes, wine shops and pubs reopened as did hotels, camping sited and other types of accommodations, including their restaurants and cafés.
Taxi services
Theatres, castles, chateaux, and other cultural activities under strictly defined hygiene rules
Cultural, social, sports events (number of persons will be more closely specified)
Others including measures pertaining to tourism

• Travel (As of April 24):

From April 27, 2020: Border crossing were once again allowed, provided special conditions were met (for details, see section 6).

• Gatherings (As of April 24):

From April 20, 2020:
Outdoor activities for professional sportsmen (without audiences) were once again allowed, though only in small groups. Weddings with participants under 10 people are allowed.

From April 24, 2020:
Any restrictions on free movement were completely revoked. Up to 10 people were allowed to be together in public spaces. Professional athletes as well as associations could once again train at facilities, in nature or in the park in small groups. Religious services with up to 15 attendants were allowed.

From May 11, 2020:
Outdoor activities for an unrestriced number of  professional sportsmen allowed.

From May 25, 2020:
Weddings once again were allowed, if special hygiene conditions are met.

Generally, most businesses (including the big shopping centers) were allowed to operate under special hygienic requirements. Universities and secondary schools remained closed, primary schools (up to 9th grade) were partially in operation

Schools (e.g. primary, higher education, etc.)

Starting May 25, students in their final year (9th grade) were allowed to return to schools. Students up to 5th grade were allowed to enter schools; since June 8, this was extended to all grades. All in-person education is limited to groups of 15 and according to hygienic regulations. Mandatory primary education has been postponed with parents deciding whether they send their child to school or not. However, once they decided, they could not change their mind (i.e. a child either participated in the on-site education at school or remained in the distance-learning group for the rest of the school year). This restriction applied until the end of the school year (June 30). Universities regulated education on their own; generally, individual in-person examination has been allowed, while non-individual examinations are performed online.

Workers (e.g. essential workers, childcare workers, etc.)

There is practically no restriction to workers except for following hygiene recommendations, Businesses have been slowly returning to normal operations. It was also recommended not to use central air conditioning.

Businesses (SMEs, restaurants, etc.)

All businesses, including indoor facilities such as swimming pools, are allowed to operate (swimming pools with certain restrictions, such as limiting the number of people and certain attractions remained closed). Restaurants are allowed to operate until 23:00, after which only “window sales” are allowed. Businesses where close contact may occur (such as tattoo salons) are allowed to operate. Restaurants in shopping centers above 5 000 m2 are allowed to operate, with. special hygiene requirements applying. These include frequent disinfection and limitation of density of the crowd.

Travel (local, cross-border, etc)

Local travel was never formally limited and, wearing masks in public transport is required. For cross-border travel, see section 6.

Gatherings (events, informal gatherings, religious services, etc.)

Gatherings are allowed up to 300 participants, including indoor events.

Transition measures: situation as of end of June 2020 (only indicated in case of changes to above)
     
Businesses (SMEs, restaurants, etc.)

All businesses, including indoor facilities like swimming pools are allowed to work (swimming pools and wellnesses with certain hygienic restrictions, such as limiting the number of people , but higher limits apply. Restaurants are allowed to operate freely.

Travel (local, cross-border, etc)

No limits on internal travel, cross-border public transit is being restored.

Gatherings (events, informal gatherings, religious services, etc.)

Indoor events are limited to 1,000 participants. Exceptions apply in several districts in Moravskoslezský region where clusters of infection emerge.
     
Face masks

Wearing face masks was required until June 14. After that date wearing masks became compulsory only indoors and in tight gatherings (below 1,5m distance) [4].  As of July 1,  the obligation to cover mouths and noses was revoked in general. However, exceptions apply for districts whereclusters of infections emerge. In Prague, wearing face masks is compulsory only when travelling by the metro (subway). 

Sources:
[1] MoH website, accessed April 27, https://koronavirus.mzcr.cz/uvolnovani-opatreni/
[2] Ministry of Interior website, accessed 22 April:  https://www.mvcr.cz/clanek/upravujeme-rezim-na-hranicich-po-velikonocich-se-mj-rozsiri-moznosti-vycestovat-do-zahranici.aspx
[3] Czech goverment website, accessed May 27, 2020
https://www.vlada.cz/cz/epidemie-koronaviru/dulezite-informace/mimoradna-opatreni-_-co-aktualne-plati-180234/#maloobchod_a_sluzby_od_11_kvetna
[4]MoH website, accessed July 3, 2020
https://www.mzcr.cz/dokumenty/v-pondeli-15cervna-dochazi-k%C2%A0dalsimu-rozvolneni-hygienickych-opatreni_19405_1.html