Policy responses for North Macedonia - HSRM

North Macedonia

Policy responses for North Macedonia

1.2 Physical distancing

The restriction of movement during the weekends was lifted from 9 May to allow more time outside. However, the Minister of Health appealed to citizens to refrain from gatherings and to abide by the government measures for physical distancing and hand hygiene.
The withdrawal of any restrictive measures was expected to lead to an increase in the number of new cases infected with coronavirus, which would then lead to adjustment and re-introduction of new measures. In May the Government developed plans for a gradual lifting of restrictive measures that reflected this, and which would be accompanied by continuous monitoring and evaluation. The plan highlighted the need to maintain measures for physical distancing overall. It was based on WHO guidance for the relaxation of restriction measures.

As of 12 May the government introduced a draft Transition Strategy which considered epidemiological measures, the national health system, and public health surveillance. The draft proposed a gradual lifting of restrictive measures, with continuous monitoring and evaluation of the situation after their withdrawal. It would be implemented in three phases according to the development of the epidemiological situation. Bars and restaurants were excluded from the first plan, with a separate plan proposed for their re-opening.
Starting on 13 May 2020, new work protocols were introduced in education and training centres, outdoor exercise of individual sports, betting houses and close shopping malls.
Selected Government officials will be allowed to take business trips abroad (although required to adhere to social distancing measures) and boards managing public companies can begin holding meetings. All businesses that include holding meetings and conferences can do so for at most six hours and will have to take mandatory breaks and have all participants wear masks and other protective equipment.
Guidance for managing issues relating to elections and election campaigning was also produced with a clear protocol for operations and voting procedures.

On 16 May 2020, the state of emergency was extended for an additional 14 days. However, curfew hours were adjusted for young people up to the age of 18 and people older than 67 years. All citizens, regardless of age, were allowed to move around outside between 05:00 and 19:00.

The Government implemented a temporary 48-hour lockdown over the holiday weekend 24-25 May, with curfew lasting from Sunday at 11:00 to Tuesday at 05:00. The reason for this was that that non-compliance with protection measures over the previous few days, primarily as a result of family gatherings, had resulted in an increase of cases.

As of 27 May 2020 the Government relaxed multiple restrictive measures, including the curfew. The measure exempting various categories from work were no longer in force, with the exception of those with chronic diseases and children up to pre-school age.
On 27 May the government published protocols for reopening and operating catering business objects and facilities, like restaurants and cafés, which were able to open on 28 May 2020. There were multiple requirements that needed to be followed such as room layout and ventilation, social distancing, and a limit on the number of people per table. Inspectors reportedly encountered significant problems when trying to control the work of restaurants and cafés under the new conditions and protocols, after they were reopened in May. These businesses had been closed for 66 days due to the governmental measures against spreading of the COVID-19.
On 30 May 2020, the Security Council extended the state of emergency for an additional 14 days.
By government decision, disinfection, observance of the minimum required distance while waiting in line, masks and gloves will be necessary while visiting shopping malls and other trade facilities for an additional 200 days after the end of the state of emergency.

On 2 June 2020 the Minister of Health stated that restriction measures could return to some areas (localized action) if epidemiological trends indicated that this was needed. A major concern was that citizens were not adhering to the recommended measures of wearing masks and keeping distance. He announced harsher controls for rule-breakers and requested higher involvement and sanctions.
Public transport returned but free public transport for retired people was canceled as of 2 June 2020. The maximum occupancy of the public transport must only be up to 50% of the capacity of the vehicles. With the new change, companies providing public transport services on the territory of Macedonia must limit the number of passengers in the vehicles to 50% of the total capacity. All passengers and drivers are obliged to wear protective equipment over their faces and all vehicles must be disinfected regularly.
All public administration employees returned to work on 2 June 2020. This excluded employees in education institutions like schools and kindergartens. All chronically ill people, as well as those with disabilities, pregnant women, single parents, those with children under 10 or children with disabilities remain relieved from work due to the coronavirus pandemic but are encouraged to work from home, if possible. New guidance on preventative measures for the workplace was produced by the government.
On 9 June 2020, the Government passed changes to the Decree on implementation of the law for the population’s protection from contagious diseases during a state of emergency.  According to the Decree, if a person refuses to accept a decision to self-isolate, provides false personal information or false data related to persons they had been in contact with in previous days, or fails to implement the measure of home self-isolation, they will be required to undergo 14-day strict isolation (quarantine) in facilities designated by the Government of North Macedonia, with the accommodation costs being covered by the person concerned.

On 12 June 2020, measures were extended to relieve from work the parents of children up to 10 years of age or in fourth grade, chronically ill and pregnant women, single parents, parents of children with disability who use the daycare center service, as well as persons who go to work accompanying completely blind people, people in wheelchairs and people with moderate and severe intellectual disabilities, with the possibility, if it is feasible, to perform their work assignments from home. The Government adopted additional protocols for camping sites.

On 15 June 2020, the President introduced a state of emergency for a period of 8 days (15-22 June 2020), upon a proposal submitted by the Government. This was done to enable the smooth preparation for the upcoming elections on 15 July, including the implementation of measures to protect public health during the election process.

The working hours of the malls returned to normal (10:00-22:00) as of 12 June 2020, except for Sunday which remains a non-working day.

The Government adopted protocols for the re-opening of hotels and other accommodation capacities around the country on 16 June 2020. These included new regulations on the number of occupants per room (2 maximum except for families where up to 4 was permitted), regular disinfection and masks to be worn.
On 19 June 2020, the Government adopted the Protocol for opening swimming pools to swimming clubs only (not for recreational purposes).
On 11 August 2020, the Government accepted changes in the protocols for intercity and international passenger transport, which instead of using up to 50% now allows for using up to 75% of the total capacity of the vehicles.

As of 26 June, gyms were allowed to open and shopping malls were able to stay open on Sundays.

On 29 June a protocol for organizing public events was announced. The protocol allowed public events; however, venues should only be filled to up to 50% of their capacity and there should be controlled entry at events. In addition, tickets must be sold online in advance, and wearing protective masks will be mandatory.

However, on the same day the Minister of Health confirmed that kindergartens will not be reopened any time soon because of a rising surge in new COVID-19 cases.

On June 30th, the Government decided to terminate the ban on sports competitions in collective sports provided there is a strict compliance to preventative measures and the lack of an audience.
On 7 July 2020, the Government adopted the protocol for operation of Day Care Centers for Children and Adults with Disabilities. They also announced that the regulation allowing citizens with children under the age of 10 to stay and work from home was officially annulled.

On 14 September 2020, the Government decided that, starting on 23 September 2020:

• Employees with chronic conditions who were released from work should go back to work. Exceptions to this decision are employees in which there is an exacerbation of the health condition and those with malignant conditions; these employees will need to provide a statement from their doctor.
• Employees on extended maternity leave should go back to work
• Taking into consideration that kindergartens have beenopen since 9 September 2020, the parents of children up to the age of 6 should go back to work.
• Parents of children up to the age of 10 attending school (either in person or online) should get back to work

On 14 September 2020, the Government decided outdoor events to be organized with 50% of the space capacity and a limited number of visitors up to a maximum of 1000 people, and indoors events with 30% of the site capacity and also maximum of 1000 people. However, several conditions remain in place for catering facilities including that live singers or music groups are not permitted in restaurant areas, only 4 people are permitted per table, and the maximum noise level is limited to 55 decibels.

On 28 October 2020, the Parliament adopted the amendments to the Law on Health Care. This included new regulations for the treatment of people with COVID-19. In addition to treatment in public health institutions, patients can now be treated and isolated in private health institutions, with prior consent from the Ministry of Health.

On 20 November 2020, the Government adopted a Decision for introducing state of emergency in the duration of 30 days on the entire territory to protect the public health and to contain the spread of SARS-CoV-2.

On 1 December 2020, the Government adopted the recommendation from the Committee for coordination and management of the system for crisis management to extend the state of emergency by 30 June 2021. They also adopted the decision of the Commission for Infectious Diseases that ski centres can be opened, including a Protocol for COVID-19 safety measures within the ski centres.

On the same day (1 December), the Government also adopted a Protocol for organizing events with media coverage during COVID-19 pandemic. This protocol regulates the presence of journalists on public events according to which the organizers of the event should ensure the safe and continuous work of journalists.

Additional restrictive measures were adopted for the period of 18 December 2020 to 20 January 2021:
• The hospitality services to be opened up until 18:00 instead of 21:00 The celebration on New Year’s Eve in open and closed spaces is prohibited
• Hotels are prohibited to organize celebrations of New Year’s Eve
• The renting of weekend houses and other tourist capacities is prohibited

On 20 January 2021, the Government annulled the decision for restaurants and other catering facilities to only work until 18:00. As of 21 January 2021, restaurants and other catering facilities can remain open until 21:00.

On 7 December 2020, the Government adopted amendments to the Immunization Program which confirmed the intention of the Ministry of Health to participate in the COVAX facility for procurement of 833,000 COVID-19 vaccines. Health workers, older people above 65 years and people with chronic cardiovascular and lung diseases will be the priority groups for vaccination.

On 15 December 2020, the Government released information regarding COVID-19 vaccinations, including with regard to the preparation of the system, the role of UNICEF as the coordinator of procurement under the COVAX mechanism, and the direct negotiations with the European Commission and EU member states.

On 26 January 2021, the Government adopted the National Plan for COVID-19 vaccination in North Macedonia. The vaccination will be implemented in three phases during which different population subgroups will be covered. The phases will be organized in line with the initial quantities of vaccines available and the risk priority vaccination groups. Three main groups will be prioritized in order to ensure the functioning of the health system, to protect those most at risk of disease, complication and death, and to maintain essential critical infrastructure services. The existing health infrastructure and professional staff who have previously been responsible for vaccinations in the country will be used for the implementation of the COVID-19 vaccination. The organization of the system will be adapted as needed by changing circumstances. Once a larger number of vaccines is available, vaccination will be implemented in a wider range with the possibility of involving more vaccination teams and opening points. The national plan also includes safe and secure logistical support for the reception, storage and distribution of vaccines to the points where the vaccination will take place.

On 10 February 2021, a website was launched allowing citizens to register their interest in COVID-19 vaccines (www.vakcinacija.mk). This platform is linked with national e-Health services. Based on the information from the platform, the family doctors will invite patients for vaccination according to the national plan for immunization. As of 19 February 2021, 91 000 citizens have expressed their interest in vaccination, of which 42,371 are people over 70 years old.

On 14 February 2021, 4680 vaccines donated from the Government of Republic of Serbia arrived in the country. Vaccination was initiated on 17 February 2021. Health workers in hospitals with high and very high risk of COVID-19 infection and transmission are a priority group in the first phase of the vaccination according to the national plan. As of 19 February 2021, 453 health workers have been vaccinated.

Physical distancing, evening curfew and further movement restrictions were introduced gradually, beginning with the closure of educational institutions and progressing to curfew hours during the day and evenings, on weekends. There were also mobility hours separating younger and older people to minimise risk. Official decisions on more stringent movement restrictions were taken after the President declared a national month-long state of emergency. 
Lockdown was imposed in cities with significant community transmission. On 13 March 2020, the municipalities Debar and Centar Zhupa declared a state of emergency and entered total lockdown.  On 26 March, Kumanovo was also isolated. All public transportation to and within these cities stopped and all shops except food stores and supermarkets closed. The Government recommended manufacturers and trade markets on the territory of Kumanovo which had large production and sales capacities to adjust their operations in order to abide by distancing restrictions in the cities, or alternatively to completely shut down. 
On 13 March 2020, all public and private gatherings were banned nationally, regardless of the number of participants. All stores, shopping malls, restaurants, and other public gathering places were closed, except for food stores, supermarkets and pharmacies – business online is encouraged. All cafes, bars, clubs, casinos and betting agencies were completely closed. All cinemas, theatre shows, sports events and concerts were cancelled. All kindergartens, schools and universities also shut on 13 March 2020. In order to support families, the Government made a decision that one parent of children under the age of 10 (or enrolled in the 4th grade) was allowed to stay at home for childcare during the time when the schools are closed. This measure was not applicable to people working in health facilities, army, fire department and police workforce. On 13 March 2020 a temporary stay at home was also announced for all employees with chronic illnesses and for pregnant women.  Diplomats were not exempted.
On 15 March 2020, the Government recommended all employers in North Macedonia to allow employees to work from home, depending on the type of work and without interrupting the regular functioning of the institution. The Ministry of Health recommended to the textile industry to organize the work process applying preventive measures, such as an appropriate distance between employees.

On 18 March 2020, the office of the Skopje Orthodox Diocese, in addition to the recomendations by the Macedonian Orthodox Church – Ohrid Archbishopric for the territory of Skopje’s Orthodox Diocese – adopted the following measures:
• All religious practices of parish priests prior to and during the Easter holidays should be stopped or postponed. Those that cannot be postponed should to be conducted in small numbers.
• Funerals and memorials should be performed only with the closest family members in the open or at graveyards.
• The use of church halls and clerical offices for meetings, religious lessons, board meetings and other irregular activities is prohibited.
• During worship services, attendees are advised to keep the recommended distance between each other.
• The monastaries should not allow in worshippers, unless there is a specific need.
• Sunday’s and festive holy liturgies should be held outdoors.
On 20 March 2020, the Government decided to ban for a period of 14 days access of persons and vehicles to the Forest Park "Vodno" after 18:00, as well as gatherings of more than five people in parks and other public places, and classes, training and exams at driver training schools. The Government obliged the Ministry of the Interior to intensify controls on private houses and villas that organize parties and gatherings (in the municipality of Sopishte and in the village of Sonje) in order to take measures to prevent such gatherings. Both the owner of the building and the persons present in the premises would be subjected to appropriate legal measures for disregarding the recommendations of the Government.
On 22 March 2020, the Government began implementing restrictions on the movement of all citizens (curfew). People have initially been forbidden to move around outside between 21:00 and 06:00 every day. On the 24 March 2020, the curfew was revised to end at 05:00 am to reduce crowding on public transport during commuting hours. Public transport across the country was discontinued between 21:00 and 05:00.

As of 25 March 2020, the movement of citizens older than 67 years was allowed only between 05:00 and 11:00 and for citizens up to 18 years between 12:00 and 21:00.
On 26 March 2020, a ban on the movement of all citizens during the weekend (Saturday and Sunday) was introduced for the time between 16:00 and 05:00. On 30 March 2020, the Government adjusted the curfew hours during the weekend– movement is allowed for pet owners and their pets between 20:00-20:30 up to 100m from the place of residence.

The authorities also adopted a measure that all markets, pharmacies, banks and post offices should have entry barriers to regulate the distance between people inside the premises, which should be at least 2 metres, and guards to regulate the number of people entering each place.
On 23 March 2020, the Government adopted a decision regarding teaching and the assessment of primary, secondary and higher education. The Government ordered schools and faculties to find ways to teach, test and evaluate pupils and students online. A national platform for e-learning was operational from the 27 March 2020. As of 8 April 2020, the Ministry of Education is considering the possibility to cancel the state graduation examination for all high school students throughout the country.

North Macedonia has a large textile industry constituting a considerable economic sector for the country. On 23 March 2020, the Government adopted a recommendation for the organization of work in factories in shifts for all companies in the country, issuing several directives:
• The number of employees in a certain facility should be limited so that there is a distance of at least 1.5 metres between each of them
• Employees should be provided with protective and disinfection equipment
• Working premises should be disinfected at least once a week
• Employees from different departments should avoid physical contact with each other as much as possible
• All meetings should be conducted via telephone, video-link or e-mail
• If any employees have been in contact with a person who has tested positive for COVID-19, they must be put in 14-day isolation at once.
On 25 March, the government banned the movement of citizens during weekends in the following days: Saturdays and Sundays from 16.00 to 05.00 am the following day with an increased presence of the police in order to prevent the clustering of individuals in groups of more than 5 persons. All previous measures remained in force. 
On 26 March, people who have pets were advised to leave home up to 200 m from their address for 30 minutes within 16:00-21:00 on weekends.
On 31 March 2020, the Government called upon all public institutions and bodies and recommended to the private sector to exempt from work all people who may need assistance – completely blind people, people with wheelchairs and people with moderate and severe intellectual disability due to the higher risk of COVID-19 complications.

On 3 April 2020, movement restriction hours were extended in Kumanovo, with a curfew during the weekend (21:00 on Friday to 05:00 on Monday) and on workdays (from 16:00 to 05:00). These new restrictions were not applicable to the police, the army or health professionals (in the public and private health sector and including family doctors). The pharmacies will also be operational. For agricultural activities, movement within the territory of the villages is permitted exclusively for working purposes.
On 6 April 2020, the Government announced that new decisions restricting the movement of all people on the entire territory of the country would enter into force on Wednesday, 8 April 2020 at 16:00. The conditions were:
- The movement of people on the entire territory of the country was to be prohibited between 16:00 and 05:00 from Monday to Friday. Only people in need of emergency medical care, with life-threatening conditions or dialysis patients, accompanied by up to two persons, will be excluded.
- During the weekends, movement was prohibited from Friday 16:00 until Monday 05:00 for all citizens.
- Citizens above 67 years of age could only move around outside between 10:00 and 12:00 from Monday to Friday.
- Young persons under 18 years old could only move around outside between 13:00 and 15:00 from Monday to Friday.
- Citizens were not allowed to move in public places in groups of more than two people – a parent can be in a greater group with their children who are under the age of 14.
- Farmers could move only within the territory of their village, exclusively for working purposes, e.g. agriculture activities.
- The police, the army, health workers, and markets and restaurants that deliver products were excluded from the ban.
- Pet owners and their pets could move between 20:00-20:30 from Monday to Sunday and between 08:00-08:30 and 15:00-15:30 during the weekend, up to 100m from the place of their residence.

The Government instructed public institutions and bodies to adjust working hours to meet the curfew starting at 16:00 on workdays (Monday-Friday). The Government instructed the Municipal Crisis Headquarters to designate economic operations (grocery stores) to provide essential groceries during the curfew.

Some municipalities were particularly concerned about the Orthodox Easter holidays period, due to fears that there would be travel between municipalities.  
North Macedonia was placed in total lock-down from Friday, 17 April at 16:00 to Tuesday, 21 April at 05:00. Movement in all picnic places, parks and forests was prohibited from Thursday, 16 April, at 16:00 to Tuesday, 21 April, at 05:00.
The period of crisis in the municipalities Debar and Center Zhupa was discontinued as of 12 April 2020. The Government concluded that this measure yielded the expected health results, and no new COVID-19 cases had occurred in Debar in the preceding 7 days.
People in Prilep, Kumanovo and Tetovo were asked to wear masks, scarfs, shawls or similar pieces of clothing to cover the mouth and nose from the 22 April 2020. Organized transport of passengers, namely entry and exit from Tetovo and the surrounding municipalities, was banned as of 21 April 2020. Air, rail and road traffic between Greece and North Macedonia was suspended until 15 May 2020.
On 20 April 2020, all institutions, agencies and local offices in Kumanovo were instructed to reduce their capacities and enforce specific protective measures for the purpose of isolating as many people as possible during this period. The Government recommends that all citizens of North Macedonia, especially those living in Kumanovo, Prilep and Tetovo, reduce outings from their homes, as well as designate one family member responsible for buying groceries and medicines.
The Prime Minister announced that the process for life to return to normal would begin after Labour Day (1 May) but cautioned that the process would be gradual and implemented in several stages.

The Government adopted a Decree with Legal force for the application of the Law on Trade during the emergency for establishing order and discipline at the entrance and inside the facilities where trade is conducted, such as retail or grocery stores, markets and bakeries, during the state of emergency. Every trader was obliged to provide security at the entrance and inside the facility, and to place appropriate markings indicating the direction of movement and observance of the minimum required distance.  Markings had to be placed at the distance of two metres in front of each cash register and in front of the entrance of the facility. Retail business owners were asked to regulate the circulation of people in their establishments, depending on the establishment’s size, i.e. to let inside one person for each 20 m2 of indoor space.

A Decree with legal force was also adopted for mandatory self-isolation during coronavirus testing. All domestic and foreign nationals, symptomatic and asymptomatic who had been tested for coronavirus, should be self-isolated from the moment of taking the test material until issuing the result. The self-isolation should last until a negative test result is obtained.
From the 23 April 2020, the Government adopted a set of changes in the duration of the curfew and the use of protective equipment by citizens:
- All movement was prohibited between 19:00 and 05:00 during weekdays across the entire territory of the country. However, during weekends, movement was prohibited from 15:00 on Saturday until 05:00 on Monday.
- During the weekdays, older people above 67 years old could move between 05:00-12:00 and young people up to age 18 can move between 13:00 to 19:00. On Saturday, older people could move between 05:00-11:00 and young people between 12:00-15:00.
- Mask or protective face coverings were mandatory outside the home, with a few specific exceptions.
The ban of gatherings and groups of people and other restrictive measures regarding physical distancing on public spaces and parks remained the same.
To support these measures, on 27 April 2020 the Commission for Infectious Diseases proposed that the Government implement sanctions for failing to abide by the mandatory protective equipment measures in public. Officials have put forward this proposal after an abundance of photographic evidence showing people not abiding to the mandatory protective equipment measure surfaced on social media.
The Government temporarily adjusted the curfew during the Labour Day (1 May) holiday weekend to tighten restrictions and prevent the risk of transmission during holiday celebrations.
The Constitutional Court eventually decided to annul the restriction of movement of young people up to the age of 18 and older people above 67 years old. The curfew was subsequently updated to cover all citizens equally, regardless of age.

On the 30 May the President declared an extension to the state of emergency by another 14 days to June 13 due to a recent increase in coronavirus cases in the country. A curfew was introduced for all Skopje municipalities, Kumanovo, Lipkovo, Stip, Tetovo, Bogovinje, Brvenica, Tearce, Zelino, and Jegunovce lasting from 21:00 on Thursday to 05:00 on Monday. In all other cities, the curfew will last from 21:00 on Thursday to 05:00 on Friday, as well as from 16:00 to 05:00 on Friday, Saturday, and Sunday. Friday was declared a non-working day for all citizens. Work in textile and leather factories in Shtip was also temporarily prohibited during an extended holiday weekend from 5-7 June.
On 9 June 2020, the Government introduced intensified controls and monitoring in targeted areas of the city of Skopje and the municipalities of Arachinovo, Studenicani, Ilinden, Petrovec and Zelenikovo, as well as the municipalities of Kumanovo, Lipkovo, Shtip and Karbinici, and Tetovo municipalities Bogovinje, Brvenica, Tarce, Zelino and Zelistrano – areas in which a larger number of new cases were registered.
After a period of gradually lifting restrictions over the summer (see Transition measures: Physical distancing), several restrictions were reintroduced due to ongoing concerns about the virus.
On the 20 Oct, the Government of North Macedonia adopted the recommendations from the Commission for Infectious Diseases at the Ministry of Health with the following new restrictive measures:
• to limit the working hours of all catering facilities to 23:00hrs, except those delivering.
• to limit the capacity of passengers on public transport to max 50% of the total number of passenger capacity in one vehicle.
• the entire state and public administration, municipalities and courts, in accordance with the principle and organization of work process of the institutions, to organize their working process in shifts, online from home or reduced by a system of rotations.
• to maintain the ban on attendance at sports competitions organized by the Handball Federation and other sports federations.
Protective masks, scarfs or other covers for the mouth and nose continue to be obligatory in all enclosed areas, such as markets, pharmacies and banks, as well as outdoors in places where there is big crowding and 2m distance can’t be easily maintained. Parliament is set to adopt the amended Law for communicable diseases and enforce a new set of recommendations including wearing a protective face mask outdoors, prohibiting the gathering of more than four people outdoors and limiting the number of visitors at homes.
On 28 October 2020, the Parliament adopted the amendments to the Law on Health Care which stipulated the following:
• Mandatory wearing of personal protection (such as a respiratory mask, disposable surgical mask, reusable textile mask, silk scarf or shawl, cotton scarf or shawl, bandana or similar) when leaving home or when moving around in public places (open and closed areas), on markets, in public transport and when entering indoor spaces with several people gathered, even if for business purposes. Failure to wear a mask outside the home is punishable by a fine of 20 euros.
• Clear regulation on self-isolation, stating that self-isolation is mandatory when testing for COVID-19 - from scheduling of the test or the testing itself, until obtaining the result. Self-isolating must also continue if the result is positive.
• Prohibition of gatherings in public space (parks, public areas or any outdoor area) in certain periods of the day and other measures determined by law.
These measures are due to last for as long as there is a danger of the COVID-19 epidemic continuing.
At the government session on 10 November various new measures were adopted to prevent the spread of the COVID-19 virus, including restrictions on working hours for catering facilities, a ban on the gathering of more than 4 people in public space after 21:00, and limits on hotel working hours. Citizens in the territory of the country were also asked not to move in public spaces after 21:00 except for urgent needs.