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important, followed by immediate hand washing after coughing/sneezing. · The use of surgical face masks decreases the risk of infecting others when worn by a person with respiratory symptoms before seeking medical advice and while being assessed. There is no evidence on the usefulness of face masks worn by persons who are not ill, therefore this is not advisable [55]. It is possible that the use of facemasks by untrained people may even increase the risk of infection due to a false sense of security and increased contact between hands, mouth and eyes. In view of scenario 4, reserving PPE for use by healthcare workers should be a priority. All people with progressing acute respiratory infections (with or without travel history) should be advised to seek medical attention, first by phone, in case symptoms worsen. Risk groups should be told to seek medical advice early, given the possibility of more rapid progression to severe disease. Social distancing measures Appropriate social distancing measures have to be strictly implemented. In the current phase of the pandemic in the EU/EEA, self-isolation of symptomatic persons and monitoring of symptoms of healthy contacts will reduce local transmission. Although there is some evidence that the infectious period may begin just before symptom onset, most of the infectiousness likely coincides with the symptomatic period, even when symptoms are mild and very non-specific. The infectious period is now estimated to last for 7-12 days in moderate cases and up to 2 weeks in severe cases [22]. Individual social distancing measures (e.g. avoiding shaking hands and kissing, and avoiding crowded transports and nonessential meetings and mass gatherings) should be recommended at organisational, national and EU levels as a preventive measure. Additional steps include school and day care measures or closures, measures at the workplace, and measures related to mass gatherings. In some countries such as China, and more recently in Italy, internal travel restrictions or “Cordon sanitaire” have been imposed on large populations together with other containment measures. The evidence for the effectiveness of closing schools and workplaces, and cancelling mass gatherings is limited. However, one modelling study from China estimated that if a range of non-pharmaceutical interventions, including social distancing, had been conducted one week, two weeks, or three weeks earlier in the country, the number of COVID-19 cases could have been reduced by 66%, 86%, and 95%, respectively, together with significantly reducing the number of affected areas [72]. School and day care measures or closure Before or instead of closures, health authorities should plan to reduce transmission opportunities within schools while children continue to attend through other measures. These may include smaller school groups, increasing physical distance between children in the class, promotion of washing of hands and outdoor classes. In the event of illness, strict isolation of sick children and staff at home or healthcare facilities is advisable in all the scenarios. The impact of generalised school closure in limiting the progression of the COVID-19 pandemic is uncertain. Evidence originating from seasonal and pandemic influenza modelling studies have shown that proactive school closures before the peak of influenza virus activity have had a positive impact in reducing local transmission and delaying the peak of the influenza activity [73]. While COVID-19 causes disease in children, it is mostly mild, and it is not known whether or the extent to which asymptomatic or mildly symptomatic children play an important role in transmission of the virus. Therefore, proactive school closures should be carefully considered in the context of a series of other prevention and mitigation layers to reduce the transmission of COVID-19 weighing the expected impact of the epidemic against the adverse effects of such closures on the community. School closures may have an impact on availability of healthcare staff, due to the need to caring for their children when not in school. Also, if grandparents are asked to care for the children, the benefits of lower transmission between children might be offset by transmission into a more vulnerable population group. In order for school closures to be effective, mixing of school-aged children in other settings outside of schools should be avoided. Proactive school closures may be considered as a means of reducing the burden of influenza cases on healthcare systems, especially if influenza is circulating in the community. This could thereby create capacity for managing cases of COVID-19 in scenarios 2 and 3. Reactive closures of schools may be necessary as a consequence of widespread virus transmission in the community and educational settings in scenario 4. Such reactive school and day-care closures will probably not reduce the impact of the epidemic, but may be needed due to high absenteeism and operational issues. Measures at the workplace Workplace measures refer to a variety of actions to reduce the risk of transmission by decreasing contact opportunities in the workplace and the community. These measures could include for example: flexible working schedules/shifts for employees, the opportunity of distance working/teleworking, encouraging
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