Policy responses for Monaco - HSRM


Policy responses for Monaco

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

1.2 Physical distancing

1.3 Isolation and quarantine

1.4 Monitoring and surveillance

1.5 Testing

From 24th January 2020, Monaco was conscious of the evolution of the epidemic worldwide, although the Principality was not yet directly affected. In preparation, a centralized call service within the Direction of Health Action was set up to answer questions from citizens and professionals and to deal with individual situations (such as suspected infection, return from a high-risk zone, etc.).

On 26 February 2020, the Prince's Government put in place the first official preventive measures to fight the spread of COVID-19. This was introduction of isolation measures in fourteen places in the event of return from high-risk zones, and regular updating of these zones according to the evolution of the "clusters” and official recommendations aimed at avoiding any private and/or professional travel to high-risk zones. The Prince's Government also widely disseminated public preventative measures to be taken and the action to be taken in the event of suspicion of infection, through the preparation and publication of "reflex sheets" on websites (including the creation of a dedicated website) and official social networks, paper posters and daily official communication with the public via internet channels. A special television programme was also broadcast on the local television channel. This was followed by the first distribution of equipment kits (masks, alcohol-based disinfectant products, protective glasses, etc.) to health professionals: first to doctors and nurses, and then to all other health professionals.

On 28th February 2020, the first case of SARS-COVID-19 contamination was confirmed in a Monégasque resident.

Due to the rapid spread of the epidemic, the notion of high-risk zones was abandoned on 20 March 2020 by the authorities.

Since 6 March 2020, the call service has been perpetuated by the creation of the COVID-19 Call Centre (epidemic information and management service). This is a dedicated telephone platform made up of staff from the Direction of Health Action, first-aid workers from the Monégasque Red Cross and a supervising doctor.

On 23rd March 2020, a Home Patient Monitoring Centre was set up to monitor the medical, psychological and social state of people diagnosed with Covid-19 but with few symptoms or presenting symptoms and therefore confined to their homes.

As of midnight on 14 March 2020, the Government introduced the closure of places returning from the public and not essential to the life of the country.

On 16 March 2020, the decision was taken to also close schools and nurseries, and teleworking was requested whenever possible.

On 17 March 2020, it was decided to limit travel to essential journeys only, such as essential employment, grocery shopping, family assistance or childcare, health reasons, leaving pets, and exercise.

The following day, March 18, 2020, construction sites were gradually brought to a standstill. Work will only resume if it was justified by respect for social distancing measures and the provision of protective equipment for workers.

On 20 March 2020, playgrounds, public gardens and access to the coast were also closed.

On 22 March 2020, a ban on night-time travel between 10 pm and 5 am was introduced in addition to existing restrictions on daytime travel.

On 27 March 2020, the Government of Monaco decided to extend the measures of containment and restriction of movement until 15 April 2020. Then, on 10 April 2020, a new extension of these measures was announced until 3 May 2020, the date on which the release from confinement would begin.

Given national specificities (including small size of the territory, low number of cases, single hospital, and close and direct links between different stakeholders) surveillance has not presented the same challenges for Monaco as in other countries.

A daily update on the number of cases and their evolution is carried out by the hospital. The most serious cases are hospitalized, and the Home Monitoring Centre is responsible for follow-up with patients who have tested positive but are either asymptomatic or only displaying mild symptoms, and are therefore able to remain at home.

The Principality's two other specialized care establishments (Monaco Cardio-Thoracic Center and the Monégasque Institute of Sports Medicine) have also been able to extend their roles to support the main hospital if required. For example, the Monégasque Institute of Sports Medicine has managed all the hospital's emergency trauma activities during this period.

The Direction of Health Action is responsible for transmitting situation reports to the World Health Organization, in accordance with the agreed procedure.

At the beginning of the epidemic, only highly symptomatic people and those in contact with them were tested. In order to avoid the risk of spreading the epidemic, they were mainly tested by RT-PCR in their homes by medical or paramedical staff.

A number of generalized testing protocols were subsequently set up for target populations such as law enforcement officers (firefighters, police officers, health workers) or teaching staff and students returning to school.

As from 19 May, Monégasque citizens and residents aged 5 years and over have been invited to be tested at specially equipped sites, from Monday to Saturday, from 8 a.m. to 6 p.m., by alphabetical order (first letter of the name of use) and on presentation of their identity card. These serological screening tests are carried out on a voluntary basis and are entirely free of charge.

As of 2 June, the same large-scale and free-of-charge screening campaign was introduced for Monégasque employees not residing in the territory. This campaign has proved particularly useful as approximately 50,000 commuters live outside the Principality but enter daily for work. This figure is significant in relation to the Principality's 38,300 inhabitants.

This screening campaign is based on the use of TROD, coupled with a quantitative test (blood test) in the event of a positive or doubtful result. To carry out this quantitative test, the persons concerned can go to the Princess Grace Hospital Centre, one of the Principality's four medical analysis laboratories or those present on French territory bordering the Principality (mainly Beausoleil).

A total of almost 35,000 people have been tested in the Principality and the prevalence rate has been fairly low at 2.8%.

Overall, Monaco’s quantitative testing capacities amount to about 440 per day. As far as RT-PCR capacities are concerned, those for sampling amount to around 60 per day and those for analysis to around a hundred. As far as ORT capacities are concerned, they amount to more than 3,000 per day.