Policy responses for Lithuania - HSRM

Lithuania


Policy responses for Lithuania

1.3 Isolation and quarantine

At the start of the epidemic, individuals who have been in China for the past 14 days were asked to self-isolate for 14 days.(1) Initially, individuals who have been to China were requested to contact the National Public Health Centre under the MOH via designated phone and email, or, if person suspected possible infection they were asked to contact the General Emergency Response Centre (112) for medical advice and follow-up.

From 6th to 10th of March, home isolation was limited to travellers coming from coronavirus affected area in China, Hong Kong, Iran, Japan, South Korea and Singapore. From 10th to 12th of March both asymptomatic and symptomatic travellers returning from extended lockdown zones including Italy, France, Germany and Spain were required to self-isolate. From 12th to 13th of March isolation was expanded to both asymptomatic and symptomatic travellers returning from all aforementioned countries plus Iceland, Norway, Sweden, Austria, Denmark, the Netherlands, Switzerland and Egypt. On 16th March, all countries were considered to be risky countries and travellers who recently returned from any foreign country were required to isolate for 14 days.(2) On 19th March, recommendations to family members of a person in a contact with COVID-19 or returning from foreign country at home were issued and stated that family members are recommended to be in a separate, well-ventilated room, if this is not possible, to keep at least 2 m away from the person in contact (e.g. sleeping in a separate bed). Guidelines on how to organize isolation in hotels (3) and medical rehabilitation premises for patients with mild form of COVID-19 (4) were issued. From 2nd April, drivers of long-haul international routes are required to self-isolate for 14 days or between shifts.

Initially with the start of the quarantine, mandatory measures were introduced for all returning travellers to be isolated in designated facilities. However, from 25th March travellers returning to Lithuania, who have the necessary conditions and accept the isolation requirements, were allowed to isolate themselves in the appropriate premises of their choice.(5) On the same day, in order to control breaches of self-isolation, the Government approved amendments to the electronic communications act by the Ministry of Communications that provided a legal basis for public authorities to obtain data on movement of persons in mandatory isolation.(6) Furthermore, substantially higher fines (warning or 500-1500 Eur fine for individuals, and 1500-6000 Eur fine for legal entities) (7) were introduced on 25th March for breaches of self-isolation and quarantine rules. Criminal liability for quarantine violations resulting in infecting other people has been tightened with a possibility of facing up to 5 years of imprisonment (it was up to 3 years previously), arrest or a fine. (12)

On 23-25 March, special recommendations for garbage disposal were provided for those in isolation (8) and for waste management of residents during quarantine (9). Updated guidelines for surface care, cleaning and disinfection of premises during isolation and quarantine were released on 27th March (10).

In a joint venture, on 7th April the National Public Health Centre together with medical professionals, municipality representatives and private sector presented a mobile app for people in quarantine and self-isolation. The app helps daily tracking of symptoms, and provides information on preventive actions and care in self-isolation. It also serves as a tracking tool for people in mandatory isolation who have signed an agreement to collect their geolocation data in real time (11).

From 11th May, some exclusions from obligation to self-isolate for 14 days for people entering the country were added: e.g. citizens of Poland and Lithuania coming for work or study reasons. From 15th May, the 14-day self-isolation requirement is lifted for citizens of Lithuania, Latvia and Estonia, traveling between the Baltic States.

Updated requirements for the isolation of the population exposed to coronavirus-infected people on municipal premises come into force on 1st of June. Municipalities will have to take care of people who have been in contact when their housing do not meet the established hygiene requirements, and people who are subject to the necessary isolation. (13) 

When requirement to self-isolate is for a person who has no option to work remotely, a certificate of incapacity for work may be issued for compulsory isolation. However, if a person travels abroad (e.g. for holidays) knowing that they will have to isolate upon their return, they will not be issued a certificate of incapacity for work. (18)

From 1st of June, Lithuanian government started to publish lists that specify who can enter Lithuania and who needs to self-isolate and be tested upon arrival. Initially the list relating to arrivals from the EU/EEA counties (14) had 3 categories: 1) countries with incidence above 25 cases per 100,000 over the past 14 days (Luxembourg, Portugal and Sweden as of 3rd July) – no arrivals except for Lithuanian citizens; 2) countries with incidence between 15 and 25 cases – recommendation to isolate for 14 days upon arrival (Bulgaria, Czechia, Romania, UK);  countries with incidence below 15 cases per 100,000 population for the last 14 days (remaining EU/EEA countries) – no restrictions. The list relating to countries “affected by COVID-19” – i.e. those countries where incidence is above 25 cases per 100,000 over the past 14 days (15) – has first been published on 17th June and lists countries from where arrivals are allowed for Lithuanian citizens and legal residents, as well as people who have permission to arrive from the Ministry of Foreign Affairs; arrivals from those countries have to isolate for 14 days (58 countries as of 3rd July).  This process has been modified on 24th July. For the EU/EEA/UK the three groups now are: 1) citizens from countries with incidence above 25 cases per 100,000 population over the past 14 days cannot enter Lithuania; 2) arrivals countries with incidence between 16 and 25 cases per 100,000 population over the past 14 days are required to self-isolate (i.e. isolation now is mandatory and not recommended); 3) no restrictions for arrivals from countries with incidence below 16 cases.(16) For Lithuanian citizens, arrivals from countries with incidence above 16 cases per 100,000 over the past 14 days are required to self-isolate. Arrivals from the list of countries “affected by COVID-19” now also has a threshold of 16 cases per 100,000 in the past 14 days, with arrivals from those countries on the list requiring to self-isolate and be tested upon arrival.(17) Both lists continue to be reviewed on a weekly basis.  On 29th of September it was stated that Poland and Estonia are on the list of countries affected by COVID-19, but isolation for people arriving from there is not required in case of transit, or travel for work, study, agricultural or health care purposes. (19)

In order to ensure safe parliamentary election process taking place in two stages on 11th and 25th October, on 5th October, MOH released recommendations on operation of polling stations for electoral commission members, observers and the public (12). Voters staying in isolation due to COVID-19 have the right to vote at home. To exercise this right, voters should fill out and sign an isolated voter request form, and send it to the Central Electoral Commission by e-mail by 7th and 21st October respectively. The voter must then wait for the members of the district election commission to contact them and inform to confirm voting from home (20).

From 16 October the isolation period for people infected with COVID-19 has been changed to correspond to scientific advice and practices in other countries. For persons with:
(a) mild form of coronavirus, isolation can be discontinued after 10 days from the onset of symptoms, if the symptoms have ceased earlier. If the symptoms of the disease disappeared after the 10th day, the isolation can be stopped 3 days after the symptoms have disappeared.
(b) severe form of coronavirus, isolation can be discontinued after 20 days if the symptoms have disappeared and no fever has been observed within 24 hours without medication.
(c) Isolation may be discontinued in patients with asymptomatic COVID-19 10 days after detection by PCR.
The changes mean that infected persons will no longer need to undergo repeated tests as previously isolation could be discontinued when a person, 14 days after testing positive for the disease, had two negative tests. 

On 19th of October, MOH has updated the rules on self-isolation for contact persons and travellers from high risk countries. Exemptions were made for people voting in Parliamentary elections on 25th October and for people visiting cemeteries around the day of the national commemoration of the dead (1st November), for athletes and their professional teams, and seafarers returning from work shift (21)

On 6th November, Korona Stop LT app was launched to inform people that they were exposed to COVID-19. (22) The app can be installed voluntarily. It warns users that over the past 14 days they have been in close range and for longer than 15 minutes to another app user who has voluntarily reported being infected with COVID-19. Along with the alert, which does not require self-isolation but only makes a person aware of risk, the app makes recommendations on what actions can help stop the virus from spreading. The app does not use any geolocation or motion data, but works through Bluetooth to detect nearby devices. By 23rd December there were 228 thousand downloads, which equates to 8.2% of population. (27) In three months, the app "Korona Stop LT" was downloaded by almost 300 thousand or 10 percent of the Lithuanian population. (32)

On 16th of November, 100.5 thousand people were in self- isolation in Lithuania. These include people with COVID-19, close contacts and those who travelled from affected countries.

In November, the government issued a number of principle for people in self-isolation to follow, including monitoring state of health for breathing difficulties; recommendation of keeping a regular contact with their GP; not to leaving the isolation site unless for exceptional/health care reasons, and, if this happens, not using public transport; refraining from accepting visitors; taking care of essentials, such as food, prescriptions, etc. remotely or ask friends or relatives to assist (in absence of such support, essential services should be provided by municipalities). (23)

In early December, the MOH has updated the isolation rules; if a person who recovered from COVID-19 is exposed to high risk within three months of becoming ill, they are no longer required to isolate. This exemption will not apply to health and social care workers, residents of nursing homes, and prison inmates. The amendments also broadened the category of persons for whom isolation may be shortened after exposure if they test negative on day 10 of isolation or after to include high-level officials, certain employees of energy companies and some other professional groups. (26)

Due to public concerns of contagiousness, people who were sick with COVID-19 can obtain a note from their e-health account where their GP confirms that the patient has recovered and can resume employment. (25)

From 7th December, municipalities are obliged to provide transport for COVID-19 patients returning home from health care facilities, e.g. when they are discharged from hospital. According to the prescribed procedure, even if the isolation period has not expired, but if the condition of a person with coronavirus allows, it can be released to continue the treatment of the coronavirus out-patiently into the house. Such a decision is made when, following the assessment of patients' health status, the emergency department finds that inpatient treatment is not required or when patients are discharged from hospital, as the state of health allows home treatment on an outpatient basis. It should be noted that not all people have the opportunity to return to the house by their own or passing transport, and by public transport such patients cannot drive. It was therefore decided that their transport should be taken care of by municipalities. (28)

On 11th December specialists from the NVSC clarified that isolation for 14 days is required after every contact with an infected person. The exception is limited to people who were sick with COVID-19 – they do not have to isolate again for three months after the disease, even if they have a high risk of exposure. (29)

From 28th of December, isolation for people with mild to moderate COVID-19 disease can be stopped 10 days after the onset of symptoms (previously this was the case for mild cases only). Isolation is also shortened for employees of certain organizations to ensure smooth functioning. (30)

According to the newly approved algorithm, the result of a serological antibody test (based on a blood sample) will be evaluated when deciding on the isolation procedure after a high-risk contact. A serological test response will be required if more than 90 days have elapsed since the illness or vaccination and the person has been exposed to high-risk contact. (31) If antibodies are detected then the isolation is not required.