November 27, 2020



This is the seventh of a series of Covid-19 newsletters from FDIME (Foundation for the Development of Internal Medicine in Europe). The aim of the newsletters is to present qualified answers to the public, specifically on issues in which internists have a saying.
In this newsletter (FAQ) you may read about measures to reduce spread of Covid 19 in the population; European experience regarding effect and consequences.
FDIME is a non-profit organizations, which aims to improve medical care for patients in Europe and has several activities promoting medical research and medical education of young European specialists in internal medicine. FDIME supports young internists to attend the European School of Internal Medicine, participate in the European Exchange program and also provide grants for research in Internal Medicine.

You are also invited to pose additional questions, which we can try to answer in one of our next newsletters.

Measures to reduce spread of Covid-19 in the population

European experience regarding effect and consequences

Covid-19 infection threatens both people and societies. Measures to reduce widespread dissemination of the virus in the population are necessary to protect frail individuals, health care, vital societal functions and economies and to save lives and reduce long-term consequences of the disease. The pressure on politicians and authorities to rapidly initiate protective measures is severe, while knowledge about which of these that are effective and what long-term consequences they might cause is sparse, particularly early on in the pandemic. Some actions are easy to initiate but might be difficult to end and in addition carry a risk of severe consequences for the society. Others demand a great deal of individual responsibility from members of the society. In addition, some of the more drastic actions may damage basic democratic and moral principles with consequences for a long time after the end of the pandemic. From a medical perspective, increased levels of unemployment and delay of diagnosis and treatment of non-Covid-19 related diseases might impair health in society to an even higher degree than Covid-19 itself.

The Table summarizes some of the more commonly used actions in the European countries, their effect on the spread of the virus and their long term consequences, based on shared European experience from the medical community.

Table. A European experience from societal measures to reduce spread of Covid-19 infection.

FeasibilityEffectEndurabilityBurden on society
1.5 meter distance++Low
Hand wash+++++Low
Stay at home when symptomatic++++Medium
Face masks+?++Low
Close down++++High
Early testing+++++Medium
Close down of schools for children++High
Restriction of outdoor activitiesHigh
Restriction of number of participants in public activities/arenas+++High
Restriction of alcohol sale in public venues++Medium
Closing boarders between countries++High


This overview suggests that measures that are easy to initiate from a political perspective often are difficult to maintain over long-time, carry a substantial risk when they end and are associated with a high burden to the society. That burden comprises both economical threats and violation of individual democratic and moral rights. In addition, restriction of individual mobility is often accompanied by a higher risk for domestic violence, alcohol and drug abuse, isolation and consequences of physical inactivity. In contrast, recommendations related to individual responsibility might be less feasible and difficult to maintain over time but are overall effective. A shared experience is that the spread of virus in schools for children is very low while the consequences of closing them are severe and thus they should remain open. Face-masks have a strong symbolic value and thereby demonstrate political power when advocated. There is a wide-spread belief that they should be protective, particularly in public settings and when visiting busy closed places. From a scientific perspective based on their use in the general population however, their effect to contribute to reducing the risk of getting infected has not been demonstrated and their ability to reduce transmission of virus from an infected person is questionable. The spread of infection is high also in communities where use of face-masks is general and the efficacy of masks varies depending on their type and the way they are used. Furthermore, the use of masks is combined with several other measures to reduce spread of infection. It should also be stressed that they accept the necessity to keep distance and to stay at home when symptomatic. On the other hand their strongest effect might be that they signal an abnormal state and thus increase awareness of risk.

In summary, it is difficult to legally prescribe common sense and responsibility. From a scientific perspective it is important to underline that several of the measures used to reduce spread of virus in the population are advocated without solid scientific evidence. The shared European experience eight months after the start of the pandemic suggests that individual responsibility in keeping distance, hand wash and staying at home when symptomatic are the most effective measures. They can also be maintained over long time without severe consequences for individuals and society. However, a far-going lock-down of the society for a short period of time seems to be an efficient way of breaking the chain of virus transmission. This carries great hope for an end to the pandemic when a vaccine can be offered to a majority of the population. As protection of the population will take time , it is recommended by authorities to continue with protective measures during the first months of the vaccination campaign.

Author: Stefan Lindgren

The Foundation for the Development of Internal Medicine (FDIME),

Daniel Sereni, Ramon Pujol, Jan Willem Elte.

With the help of Imad Hatem, Nica Cappellini, Lorenzo Dagna, Chris Davidson, Runolfur Palsson, Stefan Lindgren, Vereny Briner, Werner Bauer (in random order).