Overview of public health and social measures in the

context of COVID-19
Interim guidance
18 May 2020

Background
The overarching goal for all countries is to control COVID-19 by slowing down transmission of the virus and preventing associated
illness and death. In response to COVID-19, every country should be implementing a comprehensive set of measures, calibrated to
the local context and epidemiology of the disease.1 Central to this comprehensive strategy are time-tested, core public health
measures that break chains of person-to-person transmission, including (i) identification, isolation, testing, and clinical care for all
cases, and (ii) tracing and quarantine of all contacts,2-6 which should be a part of all national COVID-19 responses.
A comprehensive strategy to control COVID-19 will also include other public health and social measures, which are actions by
individuals, institutions, communities, local and national governments, and international bodies to suppress or stop community
spread of COVID-19.1
Public health and social measures contribute to stopping individual chains of transmission and preventing outbreaks, and are
therefore critical in limiting further spread of COVID-19, particularly while vaccines and therapeutics are not yet available. These
measures include the following:
• Personal measures aim to limit person-to-person spread, protect individuals and their contacts, and reduce contamination of
frequently touched surfaces.6,7 Personal measures include frequent hand hygiene, physical distancing, respiratory etiquette, use
of masks if ill or attending to someone who is ill, and environmental cleaning and disinfection at home.
• Physical and social distancing measures in public spaces prevent transmission between infected individuals and those who
are not infected, and shield those at risk of developing serious illness. These measures include physical distancing, reduction or
cancellation of mass gatherings,8 and avoiding crowded spaces in different settings (e.g. public transport, restaurants, bars,
theatres), working from home, staying at home, and supporting adaptations for workplaces9 and educational institutions.10 For
physical distancing, WHO recommends a minimum distance of at least one metre a between people to limit the risk of
interpersonal transmission.
• Movement measures aim to prevent introduction and limit movement of the virus from one area to another. Measures include
limiting movement of persons locally or nationally, offering guidance regarding travel, arranging orderly travel in advance to
avoid congestion at travel hubs, including train stations, bus terminals and airports, and considering a cordon sanitaire or other
selected measures when justified by the local epidemiology of COVID-19.
• Special protection measures aim to protect special populations and vulnerable groups:
• Persons at risk for more serious illness from COVID-19 (e.g. older people, persons with underlying medical conditions)
• Persons or groups with social vulnerabilities (e.g. migrant workers, refugees, displaced populations, the homeless)
• Persons or groups living in closed settings (e.g. long-term living facilities,11 places of detention, camps/camp-like settings)
• Persons or groups with higher occupational risk of exposure to the virus (e.g. staff of institutional settings, health workers
and frontline responders). Protecting health and care workers also prevents outbreaks in health facilities and residences for
seniors.
Public health and social measures provide a toolkit of interventions that countries can select and calibrate based on their local
context. National and local authorities must, however, balance interventions to address the direct health impact of COVID-19 with
strategies to limit short- and long-term consequences on health and socioeconomic wellbeing, such as arise from loss of income or
access to services, that may result from putting in place certain measures.1 Advance planning and preparedness are also critical to
avert the indirect health impact that may result when health systems are overwhelmed or other essential health and social services
are interrupted.

a
One metre is equivalent to three feet and 3.4 inches. WHO is monitoring ongoing research on risks of COVID-19 transmission.
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 Overview of public health and social measures in the context of COVID-19: Interim guidance

Purpose
The purpose of this document is to provide an overview of public health and social measures that can be implemented to slow or
stop the spread of COVID-19, and to propose strategies to limit any possible harm resulting from these interventions. b
The document is intended to inform national and local authorities and other decision-makers, who must balance public health
interventions to control COVID-19 while seeking to minimize their social and economic impact.

Applying public health and social measures according to level of disease transmission
Each category of public health and social measures—including personal, physical distancing, movement and special protection
measures—contains a range of interventions that should be selected, calibrated, and implemented based on the local intensity of
COVID-19 transmission (no cases reported, sporadic cases, clusters of cases, community transmission).6 Public health interventions
should be commensurate with the intensity of COVID-19 transmission, and any measures that countries seek to implement should
be safely adapted to ensure they are feasible, sustainable, and acceptable in the local context.
National authorities should recommend or apply measures nationally and sub-nationally based on their specific context, risk, or
level of spread, and review the situation regularly as the pandemic evolves. Communities might also adapt measures as needed,
bearing in mind local culture, living environments, and access to resources and services.
The intensity of COVID-19 transmission is typically not homogenous within a country, so national authorities should ensure that
measures that are applied are based on sub-national epidemiology and with time limits on their length of implementation. Any
adjustments to public health and social measures, and the reasons for the adjustments, should be clearly communicated to the
public.12 WHO has issued guidance to national authorities and decision makers on considerations for adjusting public health and
social measures in a gradual and phased manner as the local epidemiology of the disease changes.12,13
Table 1 outlines a range of public health and social measures countries can consider, to reduce transmission of COVID-19.

Balancing the benefits and risks of public health and social measures
The primary goal of public health and social measures is to protect health; however, the use of certain measures, including stringent
physical and social distancing and movement measures, may have harmful effects on the health and socioeconomic wellbeing of
individuals and communities. Potentially harmful consequences that may result from implementing the measures selected14 need to
be identified and managed, along with policies to maintain essential health services; protect access to food, water, and essential
goods and services; protect incomes; support families and communities; and ensure human rights for all,15 including gender
considerations.16
Addressing these concerns at both national policy and local levels will help alleviate potential burdens associated with implementing
public health and social measures and support adherence to the measures. It is also critical to adapt measures to the local context
and consider how long they can be in place. Close coordination of public health and social services is also needed to ensure everyone
knows how to seek testing or medical attention, to find and test suspected cases quickly, isolate and treat patients effectively, trace
and quarantine contacts timely, and to ensure safe discharge and appropriate post-hospital care to protect others in the community
setting.
To be effective, public health and social measures require the engagement of all members of society. Policies and interventions
should be accompanied by regular dialogue through trusted channels to provide the right information at the right time to enable
people to make informed decisions to protect themselves. Decision-makers should engage with communities and communicate
openly and regularly with people about how to implement public health and social measures throughout all phases of the emergency
response and recovery.
There is no single formula for which measures to include or how to implement them given the wide range of epidemiological
situations and social and economic contexts in which the pandemic is occurring. Mindful attention to the dual objectives of
controlling COVID-19 and protecting communities from unintended consequences of response measures will help to safeguard
health and protect well-being through all phases of response and recovery.
Table 2 suggests considerations for successful implementation of public health and social measures. Table 3 provides an overview
of policies to implement alongside public health and social measures to limit harm and support community resilience and social
cohesion.
Further considerations for measures in low-income settings are available.17

b
Guidance for personal and environmental measures, infection prevention and control, case finding and management, mass
gatherings, international travel, use of masks, schools and other topics is available at www.who.int/emergencies/diseases/novel-
coronavirus-2019.
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 Overview of public health and social measures in the context of COVID-19: Interim guidance

Table 1. Selected public health and social measures for consideration in the context of COVID-19*
Personal measures Physical and social distancing Movement measures Special protection measures
Aim: limit person-to-person spread, Aim: ensure safe physical distancing through reduced Aim: prevent introduction of virus Aim: reduce the risk of exposure of vulnerable
protect individuals and their crowding from infected areas to non-infected groups
contacts, and reduce contamination areas
Workplaces 9 Persons at risk, vulnerable persons, and others
of frequently touched surfaces
Encourage the public to practice18 • Support businesses and workplaces to put in place hand • Shelter-in-place advice for older age groups
• Offer advice regarding travel19
hygiene, physical distancing, and environmental cleaning • Protect closed settings - seniors’ residences,
• Frequent hand hygiene appropriate to circumstances, such
• Plan for business continuity and minimum services long-term11 or psychiatric care, prisons27
• Physical distancing as reducing non-essential travel or
• Where feasible, encourage teleworking, staggered shifts, how to protect oneself while • Limit visitors or allow visits only with safe
• Respiratory etiquette
flexible leave policies, teleconferences, virtual meetings, and travelling distancing
• Proper use of masks if unwell or protection for front-line workers and service personnel
• Limit movement locally, regionally, • Plan for migrants, refugees,28 displaced29 or
attending to someone who is ill
• Conduct risk assessment by workstation or function or nationally as necessary to homeless
• Environmental cleaning at home according to the environment, expected tasks, possibility of interrupt transmission or prevent • Separation from others if appropriate to context
exposure, and available resources and can be done safely and voluntarily
reintroduction
• Close non-essential businesses as transmission intensifies • In special settings, identify and plan for those at
• Arrange travel in advance as
needed (students, workers, higher risk, e.g. in shops, public transport,
Schools 10 repatriation) hospitals
Plan to safely maintain essential health services
• Support schools to put in place hand hygiene and distancing • Consider a cordon sanitaire or
border measures when justified by including immunization, prenatal care, maternity
measures, as well as environmental cleaning
local epidemiology care, cancer care and disease control efforts30
• Consider distance learning, suspension of classes, rotation
in attendance, or closing school buildings for a limited time • Consider isolation or quarantine for
• Hygiene and distancing measures in canteens and buses arriving travellers, in line with Health workers,31 frontline responders, caregivers,
national screening and testing and the health system
policy
Mass gatherings8,19 • Coordinate community services, phone hotlines,
health facilities, and emergency response units
• Conduct risk assessment 20 for high visibility events, sporting
21 and faith-based events,22 festivals, conferences to support testing, isolation, quarantine, and
referral
• Adapt, postpone, or cancel public and private events
• Support telemedicine and remote health services
• Limit size of public and private events
• Reschedule non-urgent health and medical care
• Adapt wedding, funeral and burial23 customs
• Organize services to reduce risk and frequency
of contact, ensure physical distancing in all areas
• Ensure availability of personal protective
Public spaces and transportation – equipment32
• Reduce crowding, limit access to, or close public spaces, • Implement surge plans for community clinics,
restaurants, sporting events,24 sports clubs, entertainment isolation units where preferred, hospitals, and
venues, places of worship,25 or venues with limited palliative care 33
ventilation
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 Overview of public health and social measures in the context of COVID-19: Interim guidance

• Encourage physical distancing in public places and • Coordinate health care, rehabilitation centres,
transportation (e.g. in queues and in waiting areas) and community services to ensure hospital
• Reduce mixing between individuals and households discharge planning and safe step-down care
• Communicate policy on wearing masks in public26
*WHO has developed a series of guidance on critical preparedness, readiness and response; clinical care; infection prevention and control; essential health services; essential resource planning; laboratory and diagnosis; risk
communication and community engagement; surveillance and case investigations; travel and mass gatherings, vulnerable populations; schools and institutions, and other topics, which are all available at www.who.int.

Table 2. Considerations for successful implementation of public health and social measures in the context of COVID-19
For individuals and the community Collective action and support at higher levels of government
Communicate • Communicate risk clearly34 with information on how to protect oneself and • Ccommunicate risk, policy and plans, regularly and often
effectively, others18 • Develop strategies and products to counter mis-information and myths
engage • Demystify science, simplify messages, encourage sharing of information • Engage with communities in decision-making and to strengthen engagement for public health
communities • Focus on what individuals and communities can do rather than on what not to do measures
• Offer tips on actions people can take to help others who need assistance • Identify local networks and engage communities, businesses, religious leaders, and local
• Underline personal responsibility and the role each person plays in preventing influencers;
disease and saving lives • Support police and security forces to ensure clear role and avoid mishaps
• Prevent stigma by emphasizing respect for human rights35

Enable adherence • Ensure access to affordable hygiene products and multiply wash points in public
to measures spaces,36 transport hubs, taxi stands; deploy water cisterns or other water • Train local workers or volunteers in case-finding, home visits,3 contact tracing,2 and
services where needed communication
• Facilitate access to essential services such as food shopping, essential travel, • Encourage innovation (e.g. hands-free or pedal-activated water or hand gel dispensers)
exercise, emergencies • Strengthen cleaning in offices, shops, transport, buildings, and restrooms
• Provide support to persons in isolation or quarantine • Maintain transport options for essential travel (e.g. for work, access to services and health
• Establish residential units for migrants and the homeless care)
• Establish one-way flow for services, shops and markets, to reduce crowds and • Plan early for student housing or repatriation of visitors as needed
limit the number of contacts • Consider voluntary use of phone apps to support measures, while respecting human rights
• Apply simple measures such as markings at > 1 metre intervals in shops, clinics, • Plan iterative assessment of response to adapt measures and communicate about changes
other queues, or for desk spacing in schools
• Schedule appointments for essential services to reduce waiting time, offer online
alternatives
• Provide information on proper use, care, and disposal of masks, where used

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 Overview of public health and social measures in the context of COVID-19: Interim guidance

Table 3. Sample strategies and policies for limiting secondary effects of implementing public health and social measures
For individuals and the community Collective action and support at higher levels of governance

Support family and • Propose alternatives for education10 (e.g. distance learning, coaching by library • Keep pharmacies open, protect access to essential medicines30
community staff or older siblings, or buddy systems with phone support) • Establish mental health strategies and crisis hotline
• Care for children of essential personnel, e.g. keeping schools open for them with • Ensure services and protection for migrant workers
strict hygiene and physical distancing • Develop social services to reduce risk and respond to domestic violence
• Deploy alternatives to school meals for those in need • Innovate for emergencies, e.g. establishing safe codes for victims of
• Encourage communities to support the elderly, sick, or vulnerable abuse/interpersonal violence
• Encourage social interaction by virtual means • Establish or advocate for suspension of health care user fees
• Orient social and community services to enhance resilience of communities
Protect incomes and • Pilot or support teleworking, shift changes, and physical distancing9 • Promote employee income maintenance, flexible leave policies9
the economy • Initiate flexible leave and payment policies at work • Plan for income support by employers, communities, government
• Encourage part-time work or adapted services (e.g. home delivery) • Offer social, economic, unemployment, and tax relief packages
• Implement business continuity plans for essential services and business • Develop an integrated all-of-society approach across sectors to ensure
• Engage occupational health and safety services essential services and supplies reach when and where they are needed
• Ensure access to health and social care for employees • Devise strategies and approaches, such as public health corridors, to
safely deliver supplies and services
Protect access to food • Keep food shops and supply routes open37 • Engage food producers, suppliers, and sellers to prepare, and to protect
and water • Establish priority access to shops, markets for those who need it, e.g. early safe and efficient food supply37
morning hours reserved for the elderly and the vulnerable • Pre-position and deploy food supplies to priority groups and populations in
• Encourage home preparedness for quarantine or isolation, and support access to special circumstances, including the displaced
food and supplies • Ensure food distribution in special settings and repeat as required, in
• Facilitate protection for store personnel – screens, distancing, masks humanitarian corridors where needed
• Protect harvest and food services workers; arrange safe travel as needed

Maintain essential
health services • Schedule appointments for essential health services to reduce time in open • Ensure adequate capacity for testing and contact-tracing including
waiting areas reassignment and training of non-public health staff from national or
• Pilot telemedicine and strengthen and protect access to care municipal levels
• Facilitate protection for pharmacy staff – screens, distancing, masks • Establish mechanisms to govern delivery of core and community essential
• Maintain elective surgeries and procedures in safe environment where possible, health services,30 in coordination with response protocols, while scaling
reschedule where necessary surge capacity as needed
• Guide safe care-seeking behaviours by disseminating information to the public, • Identify context-relevant list of essential services and medicines
including new pathways for services, opening hours, precautions • Optimize essential service delivery settings and platforms
• Establish effective patient flow (screening, triage and targeted referral) at all levels • Re-distribute health workforce capacity as needed, including re-assignment
and task sharing Identify mechanisms to maintain availability of and access
to essential medication and supplies

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 Overview of public health and social measures in the context of COVID-19: Interim guidance

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 Overview of public health and social measures in the context of COVID-19: Interim guidance

Additional resources
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Outbreak; 2020. (https://africacdc.org/download/guidance-on-community-social-distancing-during-covid-19-outbreak/)
European Centre for Disease Prevention and Control. Considerations relating to social distancing measures in response to
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Imperial College COVID-19 Response Team. Impact of non-pharmaceutical interventions (NPIs) to reduce COVID19
mortality and healthcare demand. 16 March 2020. London: Imperial College; 2020.
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IFRC, IOM, UNHCR and WHO. Interim guidance on scaling-up COVID-19 outbreak readiness and response operations in
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International Labour Organization (ILO) Note. COVID-19 and world of work: Impacts and responses 18 March 2020;
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New Zealand Government. COVID-19 Alert System. (https://covid19.govt.nz/alert-system/covid-19-alert-system/). 6 April
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World Health Organization. Getting your workplace ready for COVID-19, 19 March 2020 Geneva; 2020
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World Health Organization. Q & A. Considerations for the cleaning and disinfection of environmental surfaces in the
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World Health Organization. guidance for maintaining essential health services and systems.
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services-and-systems, accessed 16 May 2020)

Acknowledgements
This document was developed in collaboration with WHO Regional Offices, in reference to documents developed with
UNICEF and IFRC.

WHO continues to monitor the situation closely for any changes that may affect this interim guidance. Should any factors change,
WHO will issue a further update. Otherwise, this interim guidance document will expire 2 years after the date of publication

© World Health Organization 2020. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO licence.

WHO reference number: WHO/2019-nCoV/PHSM_Overview/2020.1

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