Pan American Health Organization · 2020
Non-pharmaceutical intervention guidance for public health authorities implementing social distancing and travel measures during COVID-19 transmission.
- Issuer
- Pan American Health Organization
- Edition
- 2020
- Audience
- Public health authorities, health ministries, emergency response coordinators
- Evidence
- Expert consensus based on early pandemic experience and existing WHO influenza pandemic guidance
- Reviewed
- 20 Oct 2026 · GMJ
What this guideline says
GMJ summary
This operational guidance document, issued by the Pan American Health Organization on 27 April 2020, provides a structured framework for implementing non-pharmaceutical public health measures to slow COVID-19 transmission across four transmission scenarios: no cases, sporadic cases, clusters of cases, and community transmission. The document emphasises that measures aim to flatten the epidemic curve, ease pressure on health services, and buy time for pharmaceutical interventions to become available.
The guidance details 15 specific action categories ranging from case detection and isolation to international traffic restrictions, with implementation tailored to transmission intensity. Key principles include implementing measures for at least two to three months based on experience from other WHO regions, adopting a whole-government approach, ensuring legal frameworks and financial protection are in place, and maintaining continuous public communication about reasons for measures and expected outcomes.
The document specifies operational requirements for each measure, including quarantine periods of 14 days for contacts, maintaining at least one-metre distance in social settings, coordinating educational facility closures with workplace policies to prevent workforce depletion, and ensuring essential services (food distribution, health care, security) continue operating throughout implementation of restrictive measures.
Key points
For clinicians — doses and thresholds as stated in the guideline
- Quarantine period for contacts is 14 days following exposure (2 days before to 14 days after symptom onset in cases)
- Contact definition includes face-to-face contact within 1 metre for more than 15 minutes, or direct physical contact with confirmed/probable cases
- Social distancing requires maintaining at least 1 metre distance between individuals in all venues and social gatherings
- Case isolation: mild cases self-isolate at home; severe cases isolated in dedicated units with cohorting considered when large numbers require treatment
- Plan implementation of social distancing measures for at least 2–3 months based on experience from other WHO regions
- Implement measures across whole country territory driven by the scenario with highest transmission intensity; staggered sub-national approach may be considered in large/federated countries
- Entry health screening at borders should implement crowd control maintaining 1-metre distance during disembarkation, immigration and customs procedures
- Essential services (food retailers, pharmacies, banking, postal services) continue with crowd control measures limiting customer numbers and maintaining distance
Actions by Transmission Scenario
Table extracted from the guideline
| Action | No cases | Sporadic cases | Cluster of cases | Community transmission |
|---|---|---|---|---|
| Early detection of cases | X | X | X | (X) |
| Case isolation | X | X | X | |
| Contact identification and quarantine | X | X | (X)* | |
| Limitation of crowding | X | X | ||
| Cancellation of mass gatherings | X | X | ||
| Educational facilities closure | X | X | ||
| Workplace closures | X | X | ||
| Business closures | X | X | ||
| Home confinement | X | X | ||
| Public transport restrictions | X | X | ||
| Specific closed settings | X | X | X | X |
| International traffic restrictions | X | X | X | X |
Source: Pan American Health Organization, Considerations on Social Distancing and Travel-Related Measures in the Context of the Response to COVID-19 Pandemic. Reproduced in summary form.
From the guideline
Verbatim
“From the experience in countries, in WHO Regions other than the Americas, having experienced different transmission scenarios since the beginning of the pandemic, it seems prudent to plan for the implementation of measures for, at least, two to three months.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As someone who has advised on health systems strengthening in the South Caucasus, I recognise that this PAHO framework offers essential scaffolding for outbreak preparedness beyond COVID-19, particularly for respiratory pathogens with similar transmission characteristics. For Georgian colleagues, the most actionable recommendation is the operational detail around maintaining essential services whilst implementing restrictions—the specifics on crowd control in pharmacies and food retailers, the logistics of home delivery for vulnerable populations, and the coordination between educational and workplace closures to prevent health workforce depletion are immediately applicable. The critical implementation challenge for Georgia and neighbouring countries will be ensuring the legal framework and financial protection mechanisms are established in advance; the document correctly emphasises that community compliance depends fundamentally on fiscal support for workers and businesses, which requires preparatory legislation and budgetary provision that cannot be improvised during an acute emergency.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 20 Oct 2026
Applicability
Georgia and the South Caucasus
For Georgia and the South Caucasus, this guidance remains relevant for preparedness planning for future respiratory pathogen outbreaks, given the region’s experience with COVID-19 and ongoing surveillance needs. National programmes should consider the document’s emphasis on coordinating measures across administrative levels—particularly important in contexts where decentralisation of health authority exists. The guidance on maintaining essential services whilst implementing restrictions, ensuring financial and fiscal protection for workers and businesses, and coordinating educational closures with workforce availability are practical considerations for resource-limited settings. Countries should adapt the framework to local legal systems, existing public health legislation, and capacity for enforcement, whilst recognising that the specific 2–3 month implementation timeframe was based on early pandemic experience and would require evidence-based adjustment for different pathogens and transmission dynamics.
Questions this guideline answers
Quick answers
What defines a contact requiring quarantine?
A contact is someone with face-to-face contact within 1 metre for more than 15 minutes, direct physical contact, or direct care without proper PPE during the period 2 days before to 14 days after symptom onset in a probable or confirmed case. Quarantine lasts 14 days.
How should educational facility closures be coordinated?
Suspension of face-to-face educational activities, especially for younger children, must be coupled with carefully thought out policy allowing caregivers to look after children; otherwise it may cause workforce depletion including health workforce. Teleteaching should be encouraged and arrangements made to prevent students travelling to hometowns in disorderly manner.
Which businesses should remain open during restrictions?
Food retailers (supermarkets) with crowd control, pharmacies, banking and postal services with limited hours, and restaurants on home-delivery basis should continue. Gymnasiums, clubs, hairdressers and beauty salons should close completely. Markets limited to food retailers with crowd control and limited hours.
What measures apply to international travellers during community transmission?
Individuals under isolation or quarantine prevented from travel. Entry allowed if strictly necessary (repatriation, humanitarian aid, essential supplies) with ad hoc arrangements. Based on risk assessment, measures range from denying entry to enforced quarantine to voluntary quarantine depending on transmission scenarios in countries of origin.
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Quality & accreditation
- ASF Hospital — Standard 5 — Safety & Emergency Preparedness
- ASF Medical Transport — Standard 5 — Infection Prevention & Control
- ASF Laboratory — Standard 7 — Examination: Process & Safety
- ASF Hospital — Standard 11 — Critical Care
- ASF Medical Transport — Standard 6 — Emergency Response During Transport
Other guidelines on this topic
- Guidance for Ethics Oversight of COVID-19 Research in Response to Emerging Evidence
- Key Considerations for Integrating Gender Equality into Health Emergency and Disaster Response: COVID-19
- Care for health workers exposed to the new coronavirus (COVID-19) in health facilities
- Considerations for the Implementation and Management of Contact Tracing for Coronavirus Disease 2019 (COVID-19) in the Region of the Americas
- Reliance for Emergency Use Authorization of Medicines and Other Health Technologies in a Pandemic (e.g. COVID-19)
- Issuer
- Pan American Health Organization
- Type
- Procedures, manuals, guidelines
- Status
- Current
- Published
- 2020-01-01
- Scope
- Non-pharmaceutical public health measures for COVID-19 pandemic response
- Audience
- Public health authorities, health ministries, emergency response coordinators
- Licence
- CC BY-NC-SA 3.0 IGO
- Evidence
- Expert consensus based on early pandemic experience and existing WHO influenza pandemic guidance
- Record history
- Created 20 Oct 2026 · updated 20 Oct 2026 · next check Apr 2027
Pan American Health Organization. Considerations on Social Distancing and Travel-Related Measures in the Context of the Response to COVID-19 Pandemic, 27 April 2020. Washington, D.C.: PAHO; 2020. (PAHO/PHE/CPI/COVID-19-20-0025). Available from: https://iris.paho.org/handle/10665.2/52409GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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