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physical distancing measures within the workspace, increased use of email and teleconferences to reduce close contacts, reduced contact between employees and customers, reduced contact between employees, adoption of flexible leave policies and promoting the use of other personal protective and environmental countermeasures [78] COVID-19 can be transmitted from person-to-person at workplaces and in other public settings where people gather in contained spaces for long periods. Viral transmission may therefore be reduced by decreasing the frequency and length of social interactions and physical contacts. Employers should encourage and support self-isolation of employees at home in case they experience respiratory symptoms; efforts should be made to identify symptomatic persons in the workplace for this purpose. Measures related to mass gatherings Mass gatherings, such as sport events, concerts, religious events and conferences increase the number of close contacts between people for long periods, sometimes in confined spaces, and may be attended by individuals who have travelled from widespread areas with differing levels of community transmission of the virus. Therefore, mass gatherings may lead to the introduction of the virus into the community hosting the event and/or facilitate virus transmission and spread. Measures to reduce the risk posed by mass gatherings include interpersonal distancing measures to avoid crowding and organisational measures, such as cancellation or postponement of an event. Data originating from seasonal and pandemic influenza models indicate that during the mitigation phase, cancellations of mass gatherings before the peak of epidemics or pandemics may reduce virus transmission. The cancellation of mass gatherings in areas with ongoing community transmission is, therefore, recommended. The decision to cancel will need to be coordinated by the organiser and public health and other national authorities. Alternative modes of broadcasting the events should be explored. In case mass gathering events take place, high risk individuals should be advised not to participate. Other personal protective and environmental measures should be implemented. Due to the significant secondary effects (social, economic, etc.) of social distancing measures, the decision on their application should be based on a case-by-case risk assessment, depending on the impact of the epidemic and the local epidemiological situation [55]. Travel-related measures Travel facilitates the spread of COVID-19 from affected to unaffected areas. Travel and trade restrictions during a public health event of international concern (PHEIC) are regulated under the International Health Regulations (IHR), part III. Travel advice When travelling it is best to avoid contact with sick persons, in particular those with respiratory symptoms and fever. Travellers should also practice good hand hygiene. Travellers who develop acute respiratory symptoms within 14 days of returning from areas with ongoing local transmission should be advised to seek immediate medical attention, ideally by phone first, and indicate their travel history to the healthcare specialist. Several EU/EEA countries have issued, or are considering, travel advice. Such advice will be less useful in scenarios 3-4, when ongoing community transmission is expected to occur in more places. Travel restrictions China, Italy and some other countries have used area quarantines, or so called ‘cordon sanitaire’ in addition to other measures on large cities, with the apparent effect on delaying the spread of this disease in China [16]. Apart from the experience in China and historical assessments of measures during the 1918 influenza pandemic, there is little evidence elsewhere to suggest that such measures would work against respiratory virus epidemics, unless implemented with such a rigour that there is absolutely no movement across the ‘cordon’ and there is very low prior transmission outside the ‘cordon’ [79]. Entry and exit screening of travellers Screening for COVID-19 involves the use of thermal scanning and/or symptom screening. Available evidence suggests that entry and exit screening are not effective in delaying or mitigating a pandemic [55,80] or detecting incoming/outgoing travellers with infectious diseases. Environmental cleaning and ventilation decontamination ECDC has published an Interim guidance for environmental cleaning in non-healthcare facilities exposed to 2019-nCoV to provide options for environmental cleaning and decontamination in non-healthcare facilities (e.g. rooms, public offices, transports, schools, etc.) where COVID-19-confirmed cases have been before being diagnosed and/or admitted to hospital [81]. Although there is no evidence of the effectiveness of mechanical or natural air ventilation to reduce COVID-19 transmission, there is mechanistic plausibility, and it should be applied, and enhanced especially in settings where people gather regularly [73]. Increasing the frequency of cleaning and maintenance of ventilation and air-conditioning units can be considered. RAPID RISK ASSESSMENT Novel coronavirus disease 2019 (COVID-2019) pandemic: increased transmission in the EU/EE Testing and surveillance strategy Laboratory testing Timely and accurate laboratory testing of specimens
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