Policy responses for Ukraine - HSRM

Ukraine


Policy responses for Ukraine

1.3 Isolation and quarantine

On 16 September, the Government adjusted epidemiological zoning criteria (Resolution # 848) as following:
- criteria for establishing “red” level of epidemiological risk: (i) bed occupancy rate is >75% for the last 5 days in a row; (ii) the incidence (new cases per 100000 population) in a region 5 times higher than the average incidence in a country;
- if 50% of the classes undergo self-isolation, the activity of the educational institutions should be suspended in “green”, “yellow”, “orange” zones;
- decisions regarding the restrictions in “red” zones (namely the activity of schools, kindergartens, etc.) will be adopted by the State Emergency Commission and Regional Emergency Commissions;
- the activity of cultural institutions is allowed in “orange” zones of epidemiological risk;
- printed materials regarding the COVID-19 spread should be available in the “orange” zone at the entrance of the institution where an event is holding.

On 13 October, the Government decided to extend the quarantine until the end of 2020. With this decision several indicators changed, particularly:
1) testing coverage targets have been doubled from 24 to 48 per 100,000 population in 7 days;
2) levels of epidemic hazards based on case incident rate per 100,000 population are used for zoning of territories:
- “yellow” – from 40 to 160 for territories with population less 70,000 and from 40 to 120 for territories with population over 70,000;
- “orange” – from 160 to 320 for territories with population less 70,000 and from 120 to 320 for territories with population over 70,000;
- “red” – over 320 for all territories;
3) Bed occupancy rate doesn’t include beds from children and other hospitals (not designated for COVID-19).
It is also forbidden to hold mass events of over 50 people in “green zone” regions, over 30 people in “yellow zone” regions and over 20 people in the “orange zone.” In all these zones, participants must be at least 1.5 meters apart.

On 12 October, Kyiv City moved from the yellow to the orange quarantine zone due to the growing COVID-19 rate and increased hospitalizations. However, the measures in the capital will be stricter than required by the orange zone to further prevent the spread of the virus, particularly: gyms and cultural establishments to be required to close, while restaurants not allowed to work past 10 p.m; mass events to be canceled and sports competitions to be held without spectators until the epidemiological situation improves.
As of 09 November 198 administrative units as of 23 regions are in a “red zone”, the rest of Ukraine in “orange” zone.

On 11 November, the Government introduced a “weekend quarantine” until 30 November. Also, anti-epidemic restrictions that were in effect for the orange quarantine zone apply to all regions of the country. The “weekend quarantine” measures are envisaged following:
Starting from 0:00 on Saturday till 0:00 on Monday it is FORBIDDEN:
- Reception of visitors in public catering establishments (bars, restaurants, cafe).
- Activities of cultural institutions and holding cultural mass events.
- Admission of visitors in shopping malls and other entertainment establishments.
- Activity of sports halls, fitness center, pools.
- Admission of visitors by entities engaged in trade and consumer services (beauty salons, manufactured goods stores, etc.)
Starting from 0:00 on Saturday till 0:00 on Monday the following is ALLOWED:
- Medical practice
- Operation of banks
- Operation of postal operators
- Trade in food, fuel, medical products, veterinary drugs, feedstuff, if they occupy at least 60% of the retail space of business entities, catering services with the use of targeted delivery of orders and takeaway orders
- Repair of computers and personal and household goods
- Operation of gas stations (without food zones), maintenance and repair of vehicles.
- The main quarantine restrictions that apply from November 13, 2020 throughout Ukraine
Also remains forbidden:
- Staying in transport and public places without a mask, as well as being outside without documents
- Carriage of more passengers in passenger transport than the number of seats (except metro)
- Operation of public catering establishments from 22:00 to 7:00 (except delivery of takeaway orders), and also operation of public catering establishments with the organization of leisure, work of night clubs
- Activities of accommodation facilities (except hotels, rehabilitation centers for people with disabilities)
- Visits to social protection institutions, with the stay of persons of senior age, and points of temporary stay of foreigners and stateless persons
- Operation of gyms, fitness centers and museums, if they have more than 1 person per 20 m2
- Operation of cinemas and theaters with more than 50% occupancy per hall
- Carrying out cultural, sports, religious and other events, if more than 20 people participate (exception: certain sports competitions)
- Visiting by a group of more than 20 persons of educational institutions, except for preschool, general secondary, out-of-school and specialized education institutions

Also, on 11 November, the Government adopted new rules reated to schools. Hence, groups of more than 20 people are prohibited to attend educational institutions throughout Ukraine, except for preschool, general secondary, extra-curricular activities and specialized art education institutions, as well as to visit certain categories of institutions if 50% of students and staff are self-isolated.

Additional credits: Dr Elina Dale; Dr Vitalii Stetsyk; Dr Liudmyla Slobodianyk;Mr Artem Skrypnyk;Ms Olga Demeshko; Ms Anastasiya Brylova; Ms Tetiana Dolhova

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*According to the national legislation (available at https://zakon.rada.gov.ua/laws/show/1645-14/print), the terms “quarantine” and “self-isolation” mean:

quarantine - administrative and health measures used to prevent the spread of highly dangerous infectious diseases;
 
self-isolation - the presence of a person in respect of whom there are reasonable grounds for the risk of infection or spread of an infectious disease, in the place (premises) determined by him in order to comply with anti-epidemic measures on the basis of the person's obligation.

On April 22 the Prime Minister announced that the Government has a very clear five stages roadmap to transition from quarantine measures and noted that the implementation of this plan would commence approximately on 12 May 2020 only if the epidemic situation was improving. For the first stage the improvement will be defined as follows: for 10 consecutive days the ratio of detected cases among all tested does not change or the daily deviation is kept within 5%; then the lifting measures will start with opening of parks, recreation areas, forest parks and coastal areas (except playgrounds); the beauty industry (partially); wholesale and retail of non-food items; coffee shops (takeaway service); car washes, bicycle shops, bicycle rental; notaries, lawyers, auditors. Additionally, restrictions can be lifted when safe conditions are met, and the new rules of operation and arrangement of measures are fulfilled by the business.
After that, the Government will embark on the implementation of the roadmap of quarantine exit and apply the next four stages. These include: 1) an increase in the number of coronavirus testing; 2) improvement in providing hospitals and doctors with necessary items and medications; 3) introduction of E-control during self-isolation as an alternative to observation; 4) creation of new rules of operation for facilities providing services to the population with compulsory social distance, face mask regime and constant disinfection procedures.
On 04 May the Prime Minister announced that the quarantine will be extended till 22 May. Starting from 11 May the Government embarked on lifting part of quarantine restrictions, particularly: opening parks, squares, recreation areas for visitors; allow beauty salons, hairdressers to operate, but on condition of abiding by certain rules, developed by the MoH; permission to public service and cultural institutions to operate according to certain criteria (museums, libraries, training of athletes of national teams and individual training as well; dentists, auditors, attorneys, notaries, home appliances repair services); summer terraces and takeout service at cafes and restaurants. As of 13 May, the Government released permission to increase the number of visitors to summer terraces - from two to four people, subjected to social distance and other anti-epidemic recommendations. In addition, groups of up to eight people were allowed to move down the street instead of two.
On 20 May, the Cabinet of Ministers extended quarantine until 22 June, but changed the modality to “adaptive quarantine” starting from 22 May (the 2d stage of quarantine easing strategy). This modality means that regional State Commissions on techno-ecological safety and emergency situations (hereafter – regional Emergency Commissions) shall be able to lift restrictions imposed in relation to prevention of COVID-19 depending on the epidemic situation in the region following consideration of all three special (public health) criteria: (i): incidence (average total number of new COVID-19 cases in the last 7 days per 100,000 population) is less than 12 new registered cases per 100,000 population; (ii) more than 50 per cent of vacant places in hospitals designated to treat COVID patients; (iii) number of tests (PSR and ELISA) conducted for seven days is more than 12 per 100,000 population.
The regions which meet all three public health criteria and decisions of the regional Emergency Commissions are made, from 22 May the public transport can start working in a regular mode, hotels to reopen, except for their indoor restaurants (besides terraces) and swimming pools. It will also possible to conduct sport events without spectators (with no more than 50 participants) and holding religious services (with no more than 1 person per square meter in the building). On 25 May, metro and kindergartens can be re-open. From 1 June, regional railways and bus transportation are expected to resume its operations, depending on the epidemic situations in regions. It’s also expected that sports facilities, gyms, fitness centers would reopen (except for classes of more than 10 people); visiting educational institutions will be allowed (conducting classes in groups of not more than 10 people). From June 10, to provide catering in indoor premises of the restaurants; activities of cultural institutions, including cultural events with participation of not more than 1 person per 5 square meters of the area where the event is held; accommodation services will resume their activity. The Government will consider renewal of air traffic after 15 June.
On 23 May, the Ministry of Heath of Ukraine has published indicators to mitigate quarantine measures in the regions.
On 1st June, the Government introduced the 3rd stage of quarantine mitigation: pools and gyms can reopen; attending educational classes in groups of no more than 10 people  is allowed; rail transport and interregional road transport are resumed. The lifting of restrictions is possible only in those regions where the epidemic situation will allow it.
Starting from 09 May, the Chief State Sanitary Doctor of Ukraine released set of interim recommendations on the organization of anti-epidemic measures during the provision of quarantine for the following services (business): beauty salons; restaurants; trade in food and non-food goods; work in office spaces; dentist services; long-term facilities (including mental health, social care homes). During May and June the State Chief Sanitary Doctor of Ukraine, has issued additional interim recommendations for different kind of operations to be applied during the period of quarantine within the frame of phasing out strategy released by the Government, among them related to: Hotels; Road passenger transportation; Educational process: conducting an external independent assessment, a single entrance exam and a single professional entrance test; Kindergartens, Metro; Gyms and pools; Football matches in Ukraine among professional football clubs; Railway passanger transportation; Trade in market places (rynok/bazar); Organization of cultural and artistic events; organization of anti-epidemic measures in some enterprises, institutions and organizations for the youth and the sphere of national-patriotic education.   
During July – September as a part of new national regulation on introduction epidemiological zoning strategy (as of 22 July 2020) the interim recommendations revised and updated, particularly on football and basketball matches activities; educational processes (schools and other educational institutions); kindergartens.
On 17 June, the Government took a decision to extend the quarantine till 31 July (the Cabinet of Ministers Resolution #500). The main provisions of restrictions are related to following measures:
- wearing a mask inside public premises and transportation is mandatory;
- the number of passengers in transport is limited to the number of seats;
- having the identification documents while going outside is mandatory;
- prohibition of visiting educational institutions in groups of more than 10 people, except for participation in external independent evaluation;
- prohibition of activities of recreation facilities for children;
- prohibition for health care facilities to carry out planned hospitalization, except in regions where the occupancy of beds in COVID-19 designated hospitals is less than 50%. Patients receiving medical care in connection with planned hospitalization are subject to mandatory testing for COVID-19.
The extended quarantine still has the «adaptive quarantine» modality where Regional Commissions on Techno-ecological Safety and Emergencies (the Regional Emergency Commissions) are be able to tighten the restrictive measures depending on the epidemical situation in the region following the consideration of public health criteria (were active till new decision entered into force as of 01 August):
- the bed occupancy rate in COVID-19 designated hospitals should be < 50%;
- the number of PCR and ELISA tests performed should be higher than 24 per 100,000 population;
- the ratio of detected cases among all tested should be within 11%;
- the incidence should be less than 8 new registered cases per 100000 population in the last 7 days.

On 22 July, the Government took a decision to extend the adaptive quarantine until August 31 (Resolution # 641 of 22 July), which also implies epidemiological zoning strategy entering into force as of 01 August and setting four epidemiological zones (“green”, “yellow”, “orange”, and “red”) depending on the COVID-19 situation in each region. The “yellow”, “orange” and “red” COVID-19 risk levels indicate a degree of the significant spread of COVID-19. The risk level to be determined by automated software according to the assessment criteria (indicators) and then formalized by a decision of the State Commission for Technogenic and Environmental Safety and Emergencies (hereafter – Commission).
Criteria (indicators) are following:
- the bed occupancy rate in COVID-19 designated hospitals is more than 50%;
- the average number of PCR and ELISA tests is less than 24 per 100 000 population in the last 7 days;
- COVID-19 case detection rate is higher than 11%;
- COVID-19 case growth rate is higher than 10%.

The Commission should approve zoning decisions on Fridays, followed by entering into force on Mondays and to be reviewed every 5 days. Zoning decisions should be submitted to the Cabinet of Ministers of Ukraine and MOH to be available on websites as the interactive map in analytical dashboards.

The transition from one zone to another is possible if there are changes in one of the defined indicators 5 days in a row.

The epidemiological risk assessment at the level of administrative-territorial units of the region – district (rayon) or cities of regional significance – to be conducted by the MOH according to the contribution (share) of a unit (city, district) in each indicator (criteria) at the regional level:
o “Green” – up to 5 percent;
o “Yellow” – from 5 to 20 percent;
o “Orange” – from 20 to 50 percent;
o “Red” – more than 50 percent.

Restriction measures are applying in all zones, but the strictest quarantine measures should be introduced in a “red” zone.
If indicators are in limits for more than 3 days, the region is considering a «green» zone with the implication of the following restrictions:
- wearing masks in transport, public buildings etc.
- carrying out mass events with the number of participants no higher than a person per 5 sq. m,
- holding events in cinemas with no more than 50% of overall facility capacity,
- the number of passengers in public transport must be equal to the number of seats.
“Yellow” zone implies the restrictions of the «green» zone and forbidden of visiting social protection institutions.
“Orange” zone forsees restrictions of the «yellow» zone and:
- prohibition of the activity of accommodation facilities, entertainment centers, gyms, cultural institutions;
- planned hospitalization is not allowed;
- prohibition of children recreation facilities activity;
- carrying out mass events with a limited number of participants (a person per 20 sq.m and not more than 100 people).
“Red” zone covers restrictions of the «Orange» zone and prohibition of:
- public transport operations;
- visiting educational institutions;
- entertainment centers activity.

The regional authorities make a decision on intensification of anti-epidemic measures through the regional commission on technogenic and environmental safety and emergencies.

Measures on border crossing:
- arriving from «green zone» countries - only insurance certificate that covers COVID-19 treatment is required;
- arriving from «red zone» countries - a certificate of insurance + self-isolation/observation for 14 days or negative results of PCR testing.
Starting from August, the MOH is updating the list of «red» zone countries on weekly basis. The following criteria used for considering a high prevalence of COVID-19 in a country:
- the number of new COVID-19 cases per 100 thousand population in the last 14 days exceeds the number of cases in Ukraine;
- the incidence exceeds 30% in the last 14 days compared to the previous 14 days.
 
Strating from 12 August, based on the Cabinet of Ministers decision # 712 the epidemiological risk to be determined according to three indicators:
- the bed occupancy rate in COVID-19 designated hospitals should not exceed 50% for 5 consecutive days;
- the average number of PCR and ELISA tests should be at least 24 per 100,000 population in the past 7 days (this indicator to be determined at the regional level);
- the COVID-19 incidence is 40 cases per 100,000 population in the past 14 days. 

Zoning decisions will be adopted by the Commission every week. The decision to relax the “red”, “orange” and “yellow” levels of epidemic danger should be reviewed no earlier than in 14 days.
The Government expanded the categories of people arriving in Ukraine from “red zone” countries (with a high prevalence of COVID-19) and do not requiring self-isolation. In particular, the list includes persons who passed PCR-test with negative result in 48 hours before crossing the border, and persons who carry hematopoietic stem cells for transplantation.

On 26 August the quarantine has been extended by 31 October. On 14 September, the Government amended Resolution #641 regarding anti-epidemic measures during the organization and holding of local elections, which stipulated the following: expenditures related to the anti-epidemic measures associated with the elections shall be covered by local budgets (including the reserve funds of these budgets); temperature screening for members of the election; at the entrance should be a place with alcohol-containing antiseptics for hands and information materials on anti-epidemic measures; at the entrance and in the polling station the marking should be applied, indicating the need to maintain physical distance of at least 1 meter and the optimal route for voting; places for centralized collection and disposal of PPE; no more than three voters should be present at the table for the ballots’ issuance at the same time; if a voter has 37.2 ° C and / or symptoms of respiratory diseases, a separate room must be arranged at each of the polling stations, where the voter can vote using a special ballot box designated for such cases; members of the election commission and persons ensuring the election process shall be placed in compliance with the requirements of physical distance (distance between seats not less than 1 meter) or with the use of physical barriers (for example, transparent screens).

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*According to the national legislation (available at https://zakon.rada.gov.ua/laws/show/1645-14/print), the terms “quarantine” and “self-isolation” mean:

quarantine - administrative and health measures used to prevent the spread of highly dangerous infectious diseases;
 
self-isolation - the presence of a person in respect of whom there are reasonable grounds for the risk of infection or spread of an infectious disease, in the place (premises) determined by him in order to comply with anti-epidemic measures on the basis of the person's obligation.

Each suspected case should be treated according to national guidelines, which requires patients to self-isolate at home (in a separate room from other family members), call a family doctor, monitor their health status and symptoms, and follow doctor’s guidance. For those with mild symptoms, self-isolation at home is required, while severe cases are hospitalized in designated hospitals. As of 17 March 2020, the Parliament introduced amendments to the Administrative Code which envisages fees for citizens who violate these measures.

As of 8 April 2020, all persons crossing the state border (including from NGCAs) are subjected to compulsory 14 days observation (quarantine) within specialized facilities (“observatories”) designated by local governments, according to approved procedure by the Cabinet of Ministers (except for persons who are employees of diplomatic missions, representations of official international missions, and their families, drivers and crew members of cargo vehicles, members of air crews and crews marine, river vessels, members of train and locomotive crews, if there is no ground to believe a person has been in contact with a COVID-19 infected person). Living expenses (except food) of persons in observatories are to be covered by local budgets (including local reserve funds). If individuals give consent to use of the app “Diy vdoma”* (“Act at home”), they can self-isolate at home.
On 13 April 2020, the Parliament adopted amendments to the Law “On protection from infectious diseases” that envisage definitions of “self-isolation”, “observatory” and “observation” as well as provisions on organizing temporary healthcare institutions (specialized hospitals). According to the new law, while quarantine or restrictive measures are in place and within 30 days from the date of their cancellation, processing of personal data is allowed without the consent of the person, including data regarding the state of health, place of hospitalization or self-isolation, last name, first name, middle name, date of birth, place of residence and work. Based on the Cabinet of Minister Decree as of 22 April, the personal data of persons who required observation (quarantine) or self-isolation may be processed only by the following persons and/or institution: healthcare workers, Ukrainian Public Health Centre (UPHC) and regional public health institutions, social workers, Police and National Guard. The Ministry of Digital Transformation and the State Security Service are responsible for information exchange between data users and for data protection.

Starting from the 1 August self-isolation is required in such cases:
- after contacting a person diagnosed with COVID-19;
- when COVID-19 case is suspected/diagnose is confirmed, but hospitalization is not required;
- after arriving from a country with high COVID-19 prevalence (“red zone” countries).
Self-isolation/observation for those arriving from «red zone» countries terminates after a negative PCR-test upon arrival in Ukraine/in 48 hours before the arrival in Ukraine.
 
• Following the experience of other countries, Ukraine has rolled out its own mobile app “Diy Vdoma” (“Act at home”) to monitor citizens in self-isolation using GPS data. The app is available in both the App Store and Google Play. The app will send its users 10 push notifications at random times for 14 consecutive days, asking them to take selfies from their place of self-isolation. The app’s artificial intelligence will then analyze the selfies for their GPS locations. Functions of the application are as follows: (i) confirmation of the location of self-isolation with location determination; (ii) photo confirmation of stay at the place of self-isolation; (iii) emergency call to the MOH hotline; (iv) planned functionality for monitoring COVID-19 symptoms development.
• On 20 May, within the framework of quarantine easing strategy through the implementation of “adaptive quarantine” (starting from 22 May), the Government adopted a procedure for anti-epidemic measures related to self-isolation by using the electronic service (web-, mobile application) "Diya".
The 14 days self-isolation is mandatory in the following cases: (i) a person had a contact with a patient with COVID-19; (ii) a person crossed the state border or crossed the checkpoints of entry into and exit from the temporarily occupied territory. Persons in self-isolation are obliged to be constantly in the place of self-isolation, to refrain from contact with persons other than those with whom they live. The supervision over a person's stay in a place of self-isolation is carried out by: (i) employees of the National Police, the National Guard following the internal order of measures to control self-isolation, state institutions of the epidemiological profile of the Ministry of Health, authorized local government officials; (ii) using the mobile application “Diya” (after installing the mobile application, the person receives a message (push-notification) at random intervals during the day. After receiving a message, the person should take a photo of the face within 15 minutes using the mobile application.

Additional credits: Dr Elina Dale; Dr Vitalii Stetsyk; Dr Liudmyla Slobodianyk;Mr Artem Skrypnyk;Ms Olga Demeshko; Ms Anastasiya Brylova; Ms Tetiana Dolhova

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*According to the national legislation (available at https://zakon.rada.gov.ua/laws/show/1645-14/print), the terms “quarantine” and “self-isolation” mean:

quarantine - administrative and health measures used to prevent the spread of highly dangerous infectious diseases;
 
self-isolation - the presence of a person in respect of whom there are reasonable grounds for the risk of infection or spread of an infectious disease, in the place (premises) determined by him in order to comply with anti-epidemic measures on the basis of the person's obligation.