Subject: RE: Our standing WB offer to support the government of Georgia during the COVID-19 crisis
From: Sebastian-A Molineus <[email-masked]>
To: Maya Tskitishvili <[email-masked]>, "[email-masked]" <[email-masked]>, "[email-masked]" <[email-masked]>, "[email-masked]" <[email-masked]>
Cc: Ekaterine Mikabadze <[email-masked]>, "[email-masked]" <[email-masked]>, "[email-masked]" <[email-masked]>, Evgenij Najdov <[email-masked]>, Lire Ersado <[email-masked]>, Abdulaziz Faghi <[email-masked]>, Jan Van Bilsen <[email-masked]>, "[email-masked]" <[email-masked]>
Date: Thu, 14 May 2020 18:40:45 +0000

FYI. the attached ppt. may be of interest as if offers comparative data.

All countries and territories affected (cases/deaths):* Albania (876/31); Andorra (756/48); Armenia (3,538/47); Austria (15,961/623); Azerbaijan (2,693/33); Belarus (24,873/142); Belgium (53,779/8,761);
Bosnia and Herzegovina (2,158/117); Bulgaria (2,023/95); Croatia (2,207/91); Czech Republic (8,198/283); Denmark (10,789/533); Estonia (1,746/61); Finland (6,003/275); France (178,349/26,994); Germany (173,034/7,713); Gibraltar (147/4); Greece (2,744/152);
Greenland (11/0); Hungary (3,313/425); Iceland (1,801/10); Ireland (23,242/1,488); Isle of Man (330/23); Italy (221,216/30,911); Jersey (294/25); Kazakhstan (5,279/32); Kosovo (884/28); Kyrgyzstan (1,037/12); Latvia (950/18); Liechtenstein (83/1); Lithuania
(1,491/50); Luxembourg (3,894/102); Malta (506/5); Moldova (5,154/182); Monaco (98/4); Montenegro (325/9); Netherlands (43,183/5,529); North Macedonia (1,674/92); Norway (8,152/228); Poland (16,921/839); Portugal (27,913/1,163); Romania (15,778/1,002); Russia
(232,243/2,116); San Marino (647/41); Serbia (10,176/218); Slovakia (1,465/27); Slovenia (1,461/102); Spain (239,639/26,744); Sweden (27,272/3,313); Switzerland (30,380/1,867); Tajikistan (729/21); Turkey (141,475/3,894); Ukraine (16,023/425); United Kingdom
(227,737/32,769); United States (1,359,319/81,805); Uzbekistan (2,519/10)

For real time* updates:  https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

*Please note there may be a lag in reporting.

Country response

Spain

The number of daily new cases fell on Tuesday to its lowest in more than two months, with 594 reported, bringing the total to 239,639; the number of fatalities rose 176 to 26,920

Spain ordered a two-week quarantine on all travelers arriving from abroad from this Friday in a bid to prevent visitors from sparking a second wave of the coronavirus, a move that will further harm a tourism
sector already reeling from the epidemic

Austria

Austria aims to ease some border controls with Switzerland within days and to end all controls by June, Chancellor said

Bosnia and Herzegovina

A senior Bosnian official in charge of procuring medical equipment to combat the coronavirus outbreak was suspended on Tuesday amid a criminal inquiry into the import of ventilators for COVID-19 patients
that proved defective

Bulgaria

Bulgaria will end its state of emergency on Wednesday, though some restrictions will remain in place and the government will be able to declare an emergency once again if the COVID-19 outbreak escalates,
parliament has decided

Denmark

Denmark is “very unlikely” to be hit by a second wave of coronavirus, the country’s chief epidemiologist said on Tuesday, after the government laid out plans for increased testing and a contact tracing
system

France

France’s death toll from the coronavirus rose by 348 to 26,991 on Tuesday, overtaking Spain to become the country with the world’s fourth-highest number of fatalities after the United States, Britain and
Italy

Across France, primary school pupils on Tuesday sat at least a meter apart in small classes and listened to teachers in masks on their first day back after two months of home-schooling during the coronavirus
lockdown

French health minister said on Tuesday that parks and gardens would remain closed in Paris and the greater Paris region to limit the risk of a second wave of coronavirus infections

Germany

The reproduction rate for the coronavirus pandemic in Germany fell below the critical threshold of 1 to an estimated 0.94 on Tuesday after a 1.07 reading on Monday, the Robert Koch Institute for public
health and disease control said

Greece

Two migrants who arrived on Greece’s outlying Lesbos island have tested positive for the novel coronavirus, migration ministry sources said on Tuesday, adding they were isolated with no contact with refugee
camps on the island

Iceland

Iceland expects to start easing restrictions for visitors arriving from overseas no later than June 15; under a plan still being developed by the authorities, travelers would be given a choice between a
test for COVID-19 upon arrival in Iceland or a two-week quarantine

Italy

Italy’s coalition parties quarreled on Tuesday over a move to grant permits to irregular migrants working in farms and as careers, in a row that delayed the approval of a stimulus package for the coronavirus-hit
economy

Deaths climbed by 172 on Tuesday and daily tally of new cases doubled to 1,402, bringing deaths to 30,911 and cases to 221,216

Poland

Poland’s main opposition grouping threatened on Tuesday to block planning for a delayed presidential election, accusing the ruling coalition of rushing a voting plan through parliament for political gain

Portugal

Portugal is to take in 500 children from Greek refugee camps as soon as restrictions on movement imposed to contain the spread of the coronavirus outbreak are lifted

Russia

Russia on Tuesday reported 10,899 new cases, bringing the nationwide total past Britain to 232,243, the third highest total worldwide; the death toll from the virus rose by 107 people to 2,116

Russian President’s spokesman said he had tested positive for the novel coronavirus and was receiving treatment at hospital, becoming the fifth senior official to contract the virus

Moscow has begun investigating the safety of a Russian-made medical ventilator, some of which have been sent to the United States, after six people died in hospital fires reported to involve two such machines

Serbia

Hundreds of Serbian Orthodox pilgrims used hand sanitizer and wore face masks as they entered the Ostrog Monastery on Tuesday, although some flouted social distancing rules designed to tackle the coronavirus
and many kissed the same holy relics and cross

United Kingdom

The United Kingdom’s COVID-19 death toll now exceeds 40,000, highest in Europe, amid 227,737 cases

A woman who worked at one of London’s busiest rail stations has died after having previously been spat at by a man who said he had the new coronavirus, her union said on Tuesday

Vatican

Pope Francis praised the work of nurses around the world on Tuesday, saying the coronavirus crisis had shown how vital their service is, as he appealed to governments to invest more in healthcare

United States

Democrats in the U.S. House of Representatives on Tuesday unveiled a $3 trillion-plus coronavirus relief package with funding for states, businesses, food support and families, only to see the measure flatly rejected by Senate Republicans

U.S. government officials are concerned that dual U.S.-Mexico citizens may flee to the United States if the coronavirus outbreak in Mexico gets worse, putting more stress on U.S. hospitals, especially near the border, officials said

Leading U.S. infectious disease expert Anthony Fauci on Tuesday warned Congress that a premature lifting of lockdowns could lead to additional outbreaks of the deadly coronavirus

Restaurants in parts of California can host sit-down dining, and shopping malls throughout the state can open for curbside pickup as coronavirus restrictions ease, Governor said

Kind regards,

Sebastian

Sebastian Molineus

Regional Director for the South Caucasus

Europe and Central Asia

T
+995 (32) 291 6238

M
+995 (577) 78 7821

M
+1 (202) 492-3914

E
[email-masked]

W
www.worldbank.org/en/region/eca

@smolineus

www.linkedin.com/in/molineus/

From: Sebastian-A Molineus

Sent: Thursday, May 07, 2020 7:36 PM

To: Maya Tskitishvili <[email-masked]>; [email-masked]; [email-masked]; [email-masked]

Cc: Ekaterine Mikabadze <[email-masked]>; [email-masked]; [email-masked]; Evgenij Najdov <[email-masked]>; Lire Ersado <[email-masked]>; Abdulaziz Faghi <[email-masked]>; Jan Van Bilsen <[email-masked]>;
[email-masked]

Subject: RE: Our standing WB offer to support the government of Georgia during the COVID-19 crisis

FYI.

All countries and territories affected (cases/deaths):* Albania (832/31); Andorra (753/46); Armenia (2,782/40); Austria (15,684/608); Azerbaijan (2,127/28); Belarus (19,255/112); Belgium (50,781/8,339); Bosnia and Herzegovina (1,987/86);
Bulgaria (1,778/84); Croatia (2,119/85); Cyprus (883/20); Czech Republic (7,933/262); Denmark (10,136/506); Estonia (1,713/55); Faroe Islands (187/0); Finland (5,573/252); France (170,694/25,538); Georgia (610/9); Germany (167,575/7,190); Gibraltar (144/4);
Greece (2,663/147); Greenland (11/0); Holy See (12/0); Hungary (3,111/373); Iceland (1,799/10); Ireland (22,248/1,375); Isle of Man (326/23); Italy (214,457/29,684); Jersey (293/24); Kazakhstan (4,422/30); Kosovo (856/27); Kyrgyzstan (871/12); Latvia (900/17);
Liechtenstein (83/1); Lithuania (1,449/48); Luxembourg (3,851/98); Moldova (4,476/143); Monaco (98/4); Montenegro (324/8); Netherlands (41,518/5,221); North Macedonia (1,539/88); Norway (7,976/216); Poland (14,740/733); Portugal (26,182/1,089); Romania (14,107/864);
Russia (165,929/1,537); San Marino (608/41); Serbia (9,677/200); Slovakia (1,429/25); Slovenia (1,448/99); Spain (239,639/25,613); Sweden (23,918/2,941); Switzerland (30,060/1,805); Tajikistan (379/8); Turkey (131,744/3,584); Ukraine (13,184/327); United Kingdom
(202,356/30,150); United States (1,219,952/72,617); Uzbekistan (2,233/10)

For real time* updates:  https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

*Please note there may be a lag in reporting.

Country Response

United Kingdom

PM said on Wednesday the situation in care homes had improved, after his health minister denied Britain had prioritized hospitals over many elderly people in homes in its fight against the coronavirus outbreak

A new government goal of reaching reach 200,000 tests by the end of the month announced by PM is an operational target to increase capacity and widen its COVID-19 testing program, his spokesman said on
Wednesday

PM said on Wednesday his government would set out details of its plan to ease a lockdown against coronavirus on Sunday, hoping that some measures could come into force the next day

Belgium

Belgian shops will be allowed to open from next Monday and people will be able to host others at their homes from Sunday, opening the door for Mother’s Day celebrations, PM said

As Belgium obliges people to wear face masks on public transport and recommends them elsewhere to limit the spread of the coronavirus, deaf people are calling for transparent masks to allow them to communicate
with others

Czech Republic

Immunity to the novel coronavirus is building up very slowly in the Czech Republic, with no more than 4-5% of the population likely to be covered, the health ministry said on Wednesday, after mass testing
for antibodies that started last month

Denmark

Danish shopping malls, cafes and restaurants will be allowed to open next Monday and older children will return to school in the second phase of Denmark’s reopening from its coronavirus lockdown, under
a government proposal set to be debated shortly

France

French president promised guaranteed stipends for out-of-work actors and money for filmmakers whose productions have been cancelled, as part of a bailout for an arts industry shut down by the coronavirus

Germany

Chancellor announced steps on Wednesday to ease the coronavirus lockdown in Germany but at the same time launched an “emergency brake” mechanism allowing for renewed restrictions in case infections pick
up again

The German federal government and the states have agreed that all shops and amateur open-air sports can restart under certain conditions and states will each decide on a gradual opening of various aspects
of public life, a draft document showed

Iceland

Iceland has all but eliminated the coronavirus outbreak as 97% of infected patients have recovered and only two new cases have been confirmed in the last week, the government said in a statement

Italy

Elderly mobsters recently let out of jail over fears they might catch the new coronavirus in Italy’s overcrowded prisons may soon be put back behind bars, justice jinister said

Deaths from the COVID-19 epidemic in Italy climbed by 369 on Wednesday and the daily tally of new infections also rose by 1,444.; the total death toll stands at 29,684 and the number of confirmed cases
amounts to 214,457

Kazakhstan

The spread of the novel coronavirus in Kazakhstan has slowed in recent days, the Central Asian nation’s government said on Wednesday, indicating it could exit a state of emergency next week

Latvia, Lithuania and Estonia

Latvia, Lithuania and Estonia will open their borders to each others’ citizens from May 15, creating a Baltic “travel bubble” within the European Union amid an easing of pandemic restrictions, their PMs
said on Wednesday

Netherlands

The Netherlands has joined several European countries in announcing the easing of its coronavirus lockdown, outlining a four-month plan to phase out social restrictions if the virus remains under control

A Dutch restaurant has come up with an idea on how to offer classy outdoor dining in the age of coronavirus - small glass cabins built for two or three people, creating intimate cocoons on a public patio

Poland

Poland’s ruling Law and Justice (PiS) party and its junior coalition partner have reached a deal to postpone the May 10 presidential vote and hold it at a later date via postal ballots, the two groupings
said in a statement

EU said Poland must ensure “free and fair” elections, as the country is locked in a spiraling political crisis over a presidential vote due this Sunday

Russia

The number of new coronavirus cases in Russia rose by 10,559, bringing the nationwide tally to 165,929, the fourth consecutive day that cases had risen by more than 10,000; 86 new fatalities from COVID-19
reported, bringing the total death toll in Russia to 1,537

Moscow mayor said on Wednesday the outbreak of the coronavirus had stabilized over the past two weeks, with the growth in cases corresponding to an increase in testing, but said self-isolation should continue;

President said he supported proposals by Moscow mayor to gradually ease some restrictions aimed at preventing the spread of the novel coronavirus

Russian foreign minister and his British counterpart discussed relations between Moscow and London and voiced intention to improve cooperation, the Russian foreign ministry said on Wednesday

Russia plans to ease its restrictions aimed at curbing the spread of the novel coronavirus in three stages; the plan outlines that at first, people will be allowed to go for walks and exercise on the streets,
and at the second stage would see educational establishments and some service-sector businesses return to operation, with recreational facilities including parks and squares then reopening in the third stage

A cruise ship has arrived in Russia’s northwesterly Murmansk region to accommodate healthy staff from a construction site run by the gas company Novatek, one of Russia’s coronavirus hotspots

Russia’s culture minister has tested positive for the coronavirus, becoming the third confirmed member of the cabinet to catch the disease

Slovakia

Slovakia reopened restaurant terraces, hotels, all shops outside large malls and other businesses on Wednesday, expediting plans to revive the economy thanks to better-than-expected progress in containing
the coronavirus outbreak

Spain

Spanish PM secured enough parliamentary votes on Wednesday to extend a state of emergency for two more weeks, allowing the government to control people’s movements as it gradually relaxes a national lockdown

Turkey

Turkey said on Wednesday it has brought the coronavirus outbreak under control, two months after it first erupted across the country, and will set out new social guidelines and business practices to prevent
any resurgence

The number of people who have died from COVID-19 in Turkey has risen by 64 to 3,584, and the overall number of cases rose by 2,253 to 131,744

Vatican

Pope Francis said on Wednesday employers must respect the dignity of workers, particularly migrants, despite economic difficulties brought on by the coronavirus crisis

United States

The United States will provide $225 million in emergency aid to Yemen to support food programs, as aid groups there are forced to scale down operations due to Houthi interference and amid a spreading coronavirus
outbreak

New members of coronavirus task force will be announced soon, as its focus turns to medical treatments and easing restrictions on businesses and social life

U.S. cities that have idled mass transit during coronavirus lockdowns are turning to an unusual partner to get essential workers to hospitals, warehouses and factories: ride-hailing company Uber

Two of the largest Roman Catholic archdioceses in America are opening up eight cemeteries for visitors in the New York City area, after closing them weeks ago due to the new coronavirus pandemic

Health officials in the U.S. state of Illinois’ Cook County, which includes the city of Chicago, will probe deaths involving heart attacks and pneumonia for indications of COVID-19 as far back as November,
a county spokeswoman said on Wednesday

Three-quarters of Americans would take a coronavirus vaccine after receiving certain assurances that it was safe, and another 9% would take one as soon as it was available, a recent poll showed

In this year’s mostly virtual commencement ceremonies, thousands of American graduates are adorning their mortarboards with the slogan “Gowns 4 Good” after donating their gowns to healthcare workers fighting
the coronavirus pandemic to use as personal protective equipment

Kind regards,

Sebastian

Sebastian Molineus

Regional Director for the South Caucasus

Europe and Central Asia

T
+995 (32) 291 6238

M
+995 (577) 78 7821

M
+1 (202) 492-3914

E
[email-masked]

W
www.worldbank.org/en/region/eca

@smolineus

www.linkedin.com/in/molineus/

From: Sebastian-A Molineus

Sent: Wednesday, May 06, 2020 3:52 PM

To: Maya Tskitishvili <[email-masked]>;
[email-masked];
[email-masked]; [email-masked]

Cc: Ekaterine Mikabadze <[email-masked]>;
[email-masked];
[email-masked]; Evgenij Najdov <[email-masked]>; Lire Ersado <[email-masked]>; Abdulaziz Faghi <[email-masked]>;
Jan Van Bilsen <[email-masked]>;
[email-masked]

Subject: RE: Our standing WB offer to support the government of Georgia during the COVID-19 crisis

Dear colleagues – please find attached our COVID-19 compendium of trends & developments in key countries across the world.

All countries and territories affected (cases/deaths):* Albania (820/31); Andorra (753/46); Angola (36/2); Armenia (2,619/40); Austria (15,650/606); Azerbaijan (2,060/26); Belarus (18,350/107); Belgium (50,509/8,016); Bosnia and Herzegovina
(1,946/79); Bulgaria (1,704/80); Croatia (2,112/83); Czech Republic (7,878/254); Denmark (10,019/503); Estonia (1,711/55); Finland (5,412/246); France (169,583/25,204); Georgia (604/9); Germany (166,696/6,993); Gibraltar (144/4); Greece (2,642/146); Greenland
(11/0); Hungary (3,065/363); Iceland (1,799/10); Ireland (21,983/1,339); Isle of Man (325/23); Italy (213,013/29,315); Jersey (293/24); Kazakhstan (4,205/29); Kosovo (855/27); Kyrgyzstan (843/11); Latvia (896/17); Liechtenstein (83/1); Lithuania (1,449/46);
Luxembourg (3,840/96); Malta (482/5); Moldova (4,363/136); Monaco (98/4); Montenegro (324/8); Netherlands (41,286/5,185); North Macedonia (1,526/86); Norway (7,928/215); Poland (14,431/716); Romania (13,837/841); Russia (155,370/1,451); San Marino (589/41);
Serbia (9,557/197); Slovakia (1,421/25); Slovenia (1,445/98); Spain (239,639/25,428); Sweden (23,216/2,854); Switzerland (30,009/1,795); Tajikistan (293/7); Turkey (129,491/3,520); Ukraine (12,697/316); United Kingdom (196,239/29,502); United States (1,199,238/70,646);
Uzbekistan (2,207/10)

For real time* updates:  https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

*Please note there may be a lag in reporting.

Country Response

United Kingdom

The United Kingdom has overtaken Italy to report the highest official death toll from the new coronavirus in Europe, figures released on Tuesday showed, increasing pressure on Prime Minister Boris Johnson
over his response to the crisis

PM will consider evidence provided by scientists at a review on Thursday before taking any decision on the next steps against the coronavirus outbreak, his spokesman said on Tuesday

Ramping up COVID-19 testing earlier would have helped the United Kingdom by allowing it to trace the contacts of those infected with the novel coronavirus, the government’s top scientific advisers told
a parliamentary committee on Tuesday

Austria

Austria’s first loosening of its coronavirus lockdown three weeks ago, in which thousands of shops reopened, has not led to a new spike in infections, though further vigilance is necessary, its health minister
said on Tuesday

Croatia

Croatia’s conservative ruling party will seek a parliamentary election during the summer depending on the evolution of the coronavirus outbreak, one of its top officials said on Tuesday

France

French President said it was unlikely that French people would be able to undertake major foreign trips this summer and that even trips within Europe may have to be limited in order to reduce the risk
of a resurgence of the coronavirus epidemic

France accused Apple on Tuesday of undermining its effort to fight the coronavirus by refusing to help make its iPhones more compatible with a planned “StopCovid” contact-tracing app

Beekeepers in France are celebrating a bumper spring honey harvest after weeks of warm weather but will need a smooth unwinding of the coronavirus lockdown if they are to find a market for their produce

Germany

The reproduction rate for the coronavirus pandemic in Germany is currently estimated at 0.71, the head of public health authority RKI said on Tuesday; the number indicates that 100 infected people infect
on average 71 others, meaning the number of new infections would fall over time

Germany on Monday announced a deal with Roche to get 3 million of the blood tests in May and 5 million every month thereafter

Germany is considering “immunity passports” after securing millions of antibody tests from Swiss drugmaker Roche; however, the health minister said that Germany could only allow coronavirus antibody tests
to help determine how freely people can move once it has advice from its ethics council

Italy

Italy’s PM said on Tuesday foreign policy had not shifted after the country received aid for the coronavirus emergency from both China and Russia, in a response to an interview with U.S. Defense Secretary

Italy plans to give work permits to thousands of irregular migrants to help farms deal with the COVID-19 epidemic that has cut the flow of cheap labor from abroad, a political source said on Tuesday

Netherlands

The mayor of The Hague on Tuesday issued a statement ordering police to break up a demonstration by around 200 people who had gathered to protest against measures ordered by the government to slow the
country’s coronavirus outbreak

The Dutch government has purchased 1 million antibody tests, the health minister said on Tuesday

Poland

The Polish Senate on Tuesday rejected government-sponsored legislation that would allow for a postal vote during a presidential election scheduled for May 10, in a widely anticipated decision

Russia

The number of coronavirus cases in Russia has risen by 10,102 to 155,370; tt also reported 95 new deaths, bringing the total death toll to 1,451

Spain

Spain reported its third day in a row of coronavirus deaths under 200, but a record number of people claiming social security benefits for April showed the cost to the economy of bringing the epidemic under
control; the country now has 239,639 cases and 25,428 deaths

Turkey

The number of people who have died from COVID-19 in Turkey has risen by 59 to 3,520 and the overall number of cases rose by 1,832 to 129,491

Turkey will start easing coronavirus containment measures this week, President said, lifting inter-city travel restrictions in seven provinces and easing a curfew imposed on senior and youth citizens

All main Turkish automotive factories will resume operations as of May 11, industry minister said, a day after President announced a normalization period to restart the economy following the coronavirus
outbreak

Ukraine

The mayor of a town in central Ukraine has unilaterally decided to ease lockdown restrictions, causing a row with President’s government as it seeks to avoid a second wave of novel coronavirus infections

United States

The U.S. Justice Department on Tuesday brought its first criminal charges against people it accused of defrauding the $660 billion Paycheck Protection Program aimed at dulling the coronavirus pandemic’s
heavy hit on the economy

A bipartisan group of Senators in the United States has introduced legislation in Congress that would allow 40,000 immigrant doctors and nurses to gain visas and work permits and join the fight against
the COVID-19 pandemic

The White House is having preliminary talks about when to wind down its coronavirus task force and may start moving coordination of the U.S. response on to federal agencies in late May, Vice President said

President on Tuesday outlined policies he suggested Congress should consider as it weighs a possible fourth round of coronavirus relief legislation, including payroll tax cuts and a business expense deduction

New York will work with the Bill & Melinda Gates Foundation to “reimagine” the state’s school system as part of broader reforms in the wake of the coronavirus pandemic, Governor said on Tuesday

A new forecast projects nearly 135,000 deaths due to COVID-19 in the United States through the beginning of August mainly due to reopening measures under way, the Institute for Health Metrics and Evaluation
(IHME) at the University of Washington said on Monday

The U.S. government has sent Mexico a plane loaded with ventilators to treat coronavirus patients, as part of an agreement between U.S. and Mexico leaders

Texas announced that nail and hair salons, and barbershops can open on Friday, while gyms and office buildings can open on May 18 with restrictions, in a partial easing of restrictions prompted by the coronavirus
outbreak

COVID-19 hits African-Americans hardest in ‘potential catastrophe of inequality’, US study finds; infection rate is 80 percent higher than among Caucasians, with other ethnic minorities also more likely
to contract disease and the finding highlights social divide and inequalities between the communities and could be happening in other U.S. cities

Kind regards,

Sebastian

Sebastian Molineus

Regional Director for the South Caucasus

Europe and Central Asia

T
+995 (32) 291 6238

M
+995 (577) 78 7821

M
+1 (202) 492-3914

E
[email-masked]

W
www.worldbank.org/en/region/eca

@smolineus

www.linkedin.com/in/molineus/

From: Sebastian-A Molineus <[email-masked]>

Sent: Monday, May 04, 2020 8:52 PM

To: Maya Tskitishvili <[email-masked]>;
[email-masked];
[email-masked]; [email-masked]

Cc: Ekaterine Mikabadze <[email-masked]>;
[email-masked];
[email-masked]; Evgenij Najdov <[email-masked]>; Lire Ersado <[email-masked]>; Abdulaziz Faghi <[email-masked]>;
Jan Van Bilsen <[email-masked]>;
[email-masked]

Subject: Re: Our standing WB offer to support the government of Georgia during the COVID-19 crisis

Dear colleagues - in case you have not yet seen, the link below is the UK government’s draft plan to ease the lockdown measures in the workplace.  As it is rather detailed there may be a number of ideas of interest to your own plans.

https://www.buzzfeed.com/alexwickham/governments-draft-plan-to-ease-lockdown-workpace-in-full

Best regards,

Sebastian

From: Sebastian-A Molineus <[email-masked]>

Sent: Monday, May 4, 2020 17:35

To: Maya Tskitishvili; [email-masked];
[email-masked]; [email-masked]'

Cc: [email-masked]'; Ekaterine Mikabadze;
[email-masked]; [email-masked]; Evgenij Najdov; Lire Ersado; Abdulaziz Faghi; Jan Van Bilsen

Subject: RE: Our standing WB offer to support the government of Georgia during the COVID-19 crisis

Dear colleagues –

FYI, attached a presentation on lessons-learned to ensure for adherence to COVID-19 guidelines. More concretely, the presentation focuses on how to ensure for effective communication campaigns and better leverage existing cash transfer
programs to this end.

Kind regards,

Sebastian

Sebastian Molineus

Regional Director for the South Caucasus

Europe and Central Asia

T
+995 (32) 291 6238

M
+995 (577) 78 7821

M
+1 (202) 492-3914

E
[email-masked]

W
www.worldbank.org/en/region/eca

@smolineus

www.linkedin.com/in/molineus/

From: Sebastian-A Molineus

Sent: Sunday, May 03, 2020 4:28 PM

To: 'Maya Tskitishvili' <[email-masked]>;
[email-masked]; [email-masked]' <[email-masked]>;
[email-masked]

Cc: [email-masked]; 'Ekaterine Mikabadze' <[email-masked]>; [email-masked]' <[email-masked]>;
[email-masked]' <[email-masked]>; Evgenij Najdov <[email-masked]>; Lire Ersado <[email-masked]>; Abdulaziz
Faghi <[email-masked]>; Jan Van Bilsen <[email-masked]>

Subject: RE: Our standing WB offer to support the government of Georgia during the COVID-19 crisis

Dear colleagues –

Please find attached the World Bank’s weekly update on Social Protection measures across the world.  Please, note, that the matrix of country interventions has been modernized/revamped to offer a more user-friendly experience, preceded
by a rapid “country at a glance” overview of key measures in place. Lots of action in 159 countries (8 more since last week). A remarkable uptick of measures in social insurance, in addition to social safety net and labor.

At the bottom of this message you will further find an update on broader COVID-19 trends & developments globally.

Kind regards,

Sebastian

159 x 752
As of today, a total of 159 countries (8 more since last week) have planned, introduced or adapted 752 social protection measures in response to COVID-19. This is over a triple in the number of countries and an eight-fold increase in measures since
the first edition of this living paper (March 20). This week’s new entries include Congo, Dominica, Gambia, Somalia, South Sudan, Sudan, Turks and Caicos, and Tuvalu.

32.4%
Cash transfers include a mix of both new and pre-existing programs of various duration and generosity. Cash transfers include 244 COVID-related measures representing one-third (32.4%) of total COVID-related social protection programs. About 59% of
cash transfer measures (122 out of 207) are new programs in 89 countries, while one-fourth of measures (26%) are one-off payments. The average duration of transfers is 2.9 months. The size of transfers is relatively generous, or 25% of monthly GDP per capita
in respective countries. On average, transfers increased by 88% compared to average pre-COVID transfer levels (where data is available for a subset of 14 countries).

3
Social assistance is being adapted in three ways. This includes expanding coverage, increasing benefits, and making administrative requirements simpler and more user-friendly. Combined, those adaptations in social assistance
benefit over 1.48 billion people (individuals). Specifically, for cash transfers administrative adaptations are occurring in 27 countries. Their coverage extension is underway in 87 countries: this includes expanding coverage of existing programs
(7 countries) and providing new programs in, as mentioned, 89 countries. Combined, those adaptations across administration, generosity and coverage in cash transfers benefit over 1.06 billion people. If we only consider coverage (horizontal expansion) of new
and existing cash transfer schemes, these cover an estimated 566.5 million people.

143%
Cash transfer programs are more than doubling in coverage, including an average of 143% in scale up levels.
Preliminary analysis for a subset of cash transfer programs with comparable data allowed to estimate the scale up of programs relative to pre-COVID19 levels.
Countries like the Philippines and El Salvador are quadrupling their coverage (in the case of Philippines also via multiple new programs), while even countries in Africa like Mauritania are almost doubling coverage.

200+
In terms of social insurance, there has been a remarkable uptick in measures recently – now breaking the ceiling of 200 measures. Gustavo Demarco, guest co-author for this edition, provides us with an overview of key issues and trends in social insurance
in COVID-response

50%+
Labor market interventions remain a key area of action. Wage subsidies continue to dominate those interventions, including accounting for over half of the LM portfolio. Our guest co-author Indhira Santos explores the variety of ways in which those
subsidies are being implemented across countries, as well as broader issues in the world of labor market COVID interventions.

0.6%
What is the full level of investment going into social protection COVID-19 response?
Our preliminary estimates indicate a level slightly higher than half-trillion (567 billion) in US dollars. Social assistance spending equals $539 billion, $488 of which in HICs. For the moment, LIC are investing $247 million in social assistance, while
MICs about $50 billion ($23 billion of which in India). Defined in these terms, the overall global volume of social protection response to COVID-19 is 0.6% of global GDP (nearly $85 trillion).

-------------------------------------------

This and previous 143 links editions are available online
here

Country updates:

All countries and territories affected (cases/deaths):* Armenia (2,148/33); Austria (15,531/589); Azerbaijan (1,854/24); Belarus (14,917/93); Belgium (49,032/7,703); Bosnia and Herzegovina (1,781/70); Bulgaria (1,555/68); Croatia (2,085/75);
Cyprus (857/20); Czech Republic (7,726/240); Denmark (9,509/460); Estonia (1,694/52); Finland (5,051/218); France (169,053/24,594); Georgia (566/6); Germany (163,855/6,670); Gibraltar (144/4); Greece (2,612/140); Greenland (11/0); Holy See (11/0); Hungary
(2,863/323); Iceland (1,798/10); Ireland (20,833/1,265); Isle of Man (315/22); Italy (207,428/28,236); Jersey (290/23); Kazakhstan (3,551/25); Kosovo (806/22); Kyrgyzstan (756/8); Latvia (870/15); Liechtenstein (83/1); Lithuania (1,449/45); Luxembourg (3,802/92);
Malta (467/4); Moldova (3,980/122); Monaco (98/4); Montenegro (322/7); Netherlands (39,988/4,893); North Macedonia (1,494/81); Norway (7,770/210); Poland (13,105/651); Portugal (25,351/1,007); Romania (12,567/744); Russia (114,431/1,169); San Marino (580/41);
Serbia (9,009/179); Slovakia (1,403/23); Slovenia (1,434/92); Spain (239,639/24,543); Sweden (21,520/2,653); Switzerland (29,705/1,754); Tajikistan (15/0); Turkey (122,392/3,258); Ukraine (10,861/272); United Kingdom (177,454/27,510); US (1,094,640/64,324);
Uzbekistan (2,075/9)

For real time* updates:  https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

*Please note there may be a lag in reporting.

Country Response

Italy

·       Deaths from the COVID-19 epidemic in Italy climbed by 269 on Friday to 28,236 and
the number of confirmed cases reaches 207,428; there are 100,943 active cases, of which 1,578 people are in intensive care and 78,249 have recovered

·       PM apologized on Friday to millions of struggling Italians who have yet to receive
long-promised financial aid meant to help them get through the coronavirus crisis

Azerbaijan

·       Azerbaijan has extended partial lockdown measures until May 31

Czech Republic

·       The Czech Republic outlined rules on Friday for cinemas, hairdressers and other businesses
to re-open on May 11; however, food and drinks are banned at the movies; hairstylists will need to wear both a mask and a protective shield, and manicurists and pedicurists must also wear gloves, with their customers must keep two meters apart

France

·       President warned on Friday that the end of the national lockdown on May 11 would
only be a first step as France looks to move out of the crisis created by the outbreak of the coronavirus

Greece

·       Greek workers and students wearing masks and gloves lined up outside parliament to
commemorate May Day, defying a government ban on movement imposed to fight the coronavirus

Hungary

·       Hungary needs to prepare for a potential second wave of coronavirus cases in October
and November after a likely slowdown in the outbreak’s infection rate in the summer, PM said

Ireland

·       Ireland on Friday announced the first small steps to easing restrictions to slow
the spread of the coronavirus and laid out a roadmap for a gradual re-opening of the economy over the coming months if the virus can be kept under control

·       Ireland’s cabinet is currently agreeing to a slight easing of coronavirus restrictions
that will allow those aged over 70 to go outside of their homes

Portugal

·       Hundreds gathered in Portugal’s capital Lisbon on Friday to celebrate Labor Day,
observing strict social distancing rules in a smaller-than-usual event to show solidarity with those left jobless due to the coronavirus outbreak

Russia

·       Russia on Friday reported a record daily rise in the number of confirmed coronavirus
cases, with 7,933 cases reported, bringing the total to 114,431; 96 people had died, raising the death toll up to 1,169

Spain

·       Spain’s coronavirus death toll rose to 24,824 on Friday as 281 more people died;
the number of cases rose to a total 215,216

·       Spain closed a giant temporary hospital in Madrid that had become a symbol of its
fight against the coronavirus pandemic on Friday and people prepared to emerge from their homes for walks in the street after seven weeks of strict lockdown

Turkey

·       The number of people who have died from COVID-19 in Turkey has risen by 84 to 3,258,
and 2,188 new cases has brought the total number of cases to 122,392

United Kingdom

·       Britain has hit its target of carrying out 100,000 COVID-19 tests a day, health minister
said on Friday, stressing that the program was crucial to helping ease a national lockdown; 122,347 tests were conducted on Friday

·       Many Britons would be uncomfortable leaving their homes even if the government ordered
the lifting lockdown restrictions in a month’s time, according to a poll on Friday

·       People from some ethnic minorities in Britain are dying in disproportionate numbers
from COVID-19, possibly in part because they are more likely to work in healthcare and other sectors most exposed to the virus, a leading think tank said on Friday

United States

·       The U.S. Navy hospital ship Comfort departed New York harbor, just a month after
arriving to help ease the strain on overburdened city hospitals dealing with the novel coronavirus outbreak

·       U.S. manufacturing activity plunged to an 11-year low in April as the novel coronavirus
wreaked havoc on supply chains, suggesting the economy was sinking deeper into recession

·       Treasury said private schools with significant endowments and have taken loans from
the coronavirus stimulus law should return them

·       A report released by CDC highlighted four main factors that accelerated transmission
in March: 1) continued importation of the virus by travelers infected elsewhere, such as on cruise ships; 2) attendance at professional and social events, which amplified the spread; 3) introduction of the virus into facilities prone to amplification, including
nursing homes and high-density urban areas; 4) problems detecting virus, including limited testing, the virus’ emergence during flu season, and “cryptic transmission” from people who were asymptomatic or pre-symptomatic

·       More than 4,900 workers in meat and poultry processing facilities have contracted
Covid-19 and at least 20 have died, according to CDC report released Friday

·       New York Governor said all state schools would stay closed for the rest of the academic
year due to the coronavirus pandemic, even as hospitalizations and the daily death toll fell to their lowest levels in more than a month

·       New York City’s subway is taking the unprecedented step of halting overnight service
in order to clean train cars, a likely prelude to bigger changes as the largest U.S. mass transit system works to rebound from a pandemic that has slashed ridership

·       Hundreds of demonstrators gathered in Huntington Beach, California, a day after the
governor announced an order to close all beaches in Orange County

Kind regards,

Sebastian

Sebastian Molineus

Regional Director for the South Caucasus

Europe and Central Asia

T
+995 (32) 291 6238

M
+995 (577) 78 7821

M
+1 (202) 492-3914

E
[email-masked]

W
www.worldbank.org/en/region/eca

@smolineus

www.linkedin.com/in/molineus/

From: Sebastian-A Molineus

Sent: Thursday, April 30, 2020 8:08 PM

To: Maya Tskitishvili <[email-masked]>;
[email-masked];
[email-masked]

Cc: [email-masked]; Ekaterine Mikabadze <[email-masked]>;
[email-masked]; Evgenij Najdov <[email-masked]>; Lire Ersado <[email-masked]>; Abdulaziz Faghi
<[email-masked]>; Jan Van Bilsen <[email-masked]>

Subject: RE: Our standing WB offer to support the government of Georgia during the COVID-19 crisis

Dear colleagues –

FYI and I trust you will find this COVID-19 update on how other countries are addressing/ leading their response to the pandemic useful.

Country Response

Italy

Italian PM defended himself on Tuesday from widespread criticism of his highly cautious plans for a slow-placed end to Europe’s longest coronavirus lockdown

Workers in face masks laid the final section of a new viaduct in Genoa on Tuesday, as Italy’s prime minister paid tribute to the 43 people killed when the road bridge it is replacing collapsed less than
two years ago

Austria

Austria will take further steps to ease its lockdown on Friday, allowing events with up to 10 people and instructing the public they no longer need a specific reason to leave home, the government said
on Tuesday

Czech Republic

The lower house of the Czech parliament voted on Tuesday to extend a state of emergency until May 17, a week less than the government had sought, as the country charts a course to emerge from a coronavirus
lockdown earlier than forecast

France

France will begin to ease its coronavirus lockdown from May 11 to avoid an economic meltdown, PM said on Tuesday, but he warned that infections would spiral higher again if the country moved too swiftly

France will implement a new doctrine on COVID-19 testing from May 11 with the aim of testing everyone who has come into contact with people who are infected, and the government had set the goal of carrying
out at least 700,000 tests per week

The French parliament will not discuss government plans for a coronavirus contact-tracing app during Tuesday’s debate about the end of the lockdown period

French secondary school pupils returning to school next month after a coronavirus lockdown will be required to wear masks

Non-essential French retailers can re-open their doors from May 11, but they will have the right to insist that shoppers wear masks on the premises

Germany

Governments should focus on climate protection when considering fiscal stimulus packages to support an economic recovery from the coronavirus pandemic, German Chancellor said

Greece

Greek PM said restrictions on citizens’ movements would be lifted and more shops allowed to reopen from May 4 in a gradual easing of a lockdown imposed to curb the spread of the new coronavirus

Hungary

Hungary’s government plans to ease the lockdown and has outlined of the plans on Tuesday; starting next week, smaller retail outlets may open and over the course of May, a gradual opening of hotels, restaurants
and coffee shops may follow

Portugal

President said Portugal’s lockdown will be lifted gradually from May 3

Romania

A parliament election in Romania scheduled for late November or early December might not take place this year unless the new coronavirus spread is contained, President said

Russia

President extended coronavirus lockdown measures for another two weeks on Tuesday, while ordering his government to begin preparations for a gradual lifting of the curbs from mid-May

Spain

Spanish PM announced on Tuesday a four-phase plan to lift the lockdown with an aim to return to normality by the end of June; the lifting of the strict measures will begin on May 4 and vary from region
to region depending on factors such as how the rate of infection evolves, the number of intensive care beds available locally and how regions comply with distancing rules, he said

On the tourism-dependent Spanish island of Mallorca, a total shutdown of hotels due to the coronavirus outbreak has destroyed livelihoods across the sector, from reception staff to farmers who provide
food for restaurants

Turkey

Turkey’s government aims to begin reviving the economy in late May after a sharp slowdown due to measures to contain the coronavirus outbreak, while minimizing the risk of a second wave of infections,
a senior official said on Tuesday

The traditional lighting that hangs between the minarets of Turkish mosques, usually packed for evening prayers in the holy month of Ramadan, is urging Turks to stay at home this year as the country battles
the coronavirus pandemic

United Kingdom

Some children in the United Kingdom with no underlying health conditions have died from a rare inflammatory syndrome which researchers believe to be linked to COVID-19, Health Secretary said

Britain is not yet at the point of wanting to change its strict guidelines on social distancing to curb the spread of COVID-19, with the government focusing on reviewing the measures by May 7, PM said
on Tuesday

Scotland’s First Minister has urged people to start wearing a face mask if they are in enclosed places such as public transport and shops, diverging for now from the official advice from London

Vatican

Pope Francis urged people to obey rules aimed at preventing a devastating second wave of infections as their leaders begin to ease coronavirus lockdowns

United States

A Turkish military plane carrying medical supplies and protective equipment was heading for the United States on Tuesday to deliver aid

Lawmakers in the House of Representatives will not return to Washington next week as planned, due to the continuing risk of coronavirus infection, Democratic leaders said on Tuesday, in a reversal of plans
outlined only a day earlier

U.S is considering having passengers on international flights from coronavirus hot spots be tested for the virus

U.S meat processing plants facing concerns about coronavirus outbreaks may stay open to protect the country’s food supply, a senior administration official said

Tourists and other visitors to the U.S Capitol and adjacent congressional offices will continue to be suspended until May 16, Senate and House of Representatives officials said

New York Governor said that new hospitalizations for the novel coronavirus dropped to a one-month low and laid out a plan to employ thousands of case investigators under criteria for reopening his state

Detroit residents waited for hours on Tuesday to get free COVID-19 tests at a new facility that for the first time offered testing to people who did not already have symptoms of the disease and a doctor’s
authorization for the test

Some California workplaces, schools and childcare facilities can gradually reopen once the state improves coronavirus testing and contact tracing, the state’s health officer said

Ohio was holding nominating contests largely by mail on Tuesday after voting originally scheduled for March 17 was delayed and in-person balloting curtailed, as the coronavirus pandemic further disrupted
the U.S election season

YouTube said it would start showing text and links from third-party fact-checkers to U.S viewers, part of efforts to curb misinformation of COVID-19 on the site

As Detroit’s automakers seek to restart their U.S plants during the coronavirus pandemic, two health experts advising Michigan’s governor and the United Auto Workers union warned against an over-reliance
on masks and face shields to keep workers safe

Fewer than half of Americans plan to go to sports events, concerts, movies and amusement parks when they reopen to the public until there is a proven coronavirus vaccine, according to a recent poll

Kind regards,

Sebastian

Sebastian Molineus

Regional Director for the South Caucasus

Europe and Central Asia

T
+995 (32) 291 6238

M
+995 (577) 78 7821

M
+1 (202) 492-3914

E
[email-masked]

W
www.worldbank.org/en/region/eca

@smolineus

www.linkedin.com/in/molineus/

From: Sebastian-A Molineus

Sent: Monday, April 20, 2020 5:16 PM

To: [email-masked];
[email-masked]; Mikheil Chkhenkeli <[email-masked]>; Maya Tskitishvili <[email-masked]>

Cc: [email-masked]; Ekaterine Mikabadze <[email-masked]>;
[email-masked]; Evgenij Najdov <[email-masked]>; Lire Ersado <[email-masked]>; Abdulaziz Faghi
<[email-masked]>; Jan Van Bilsen <[email-masked]>

Subject: RE: Our standing WB offer to support the government of Georgia during the COVID-19 crisis

Dear colleagues –

I trust you all had a nice Easter weekend with your families.  For this coming week, please find below a series of publications and good practice notes prepared by the World Bank.  I trust you will forward these to your teams and other
relevant government departments preparing the government’s policy responses; please do let me know if you would like for me to incl. others in this distribution list (I try to target as much as possible to avoid spamming you with emails).

More concretely:

Phase 2 support: The first is a longer publication (“COVID-19 Policy Response.pdf”), which sets out to advise governments as they prepare for the second phase of the response to COVID-19, focusing on social protection and economic recovery.  This note
addresses issues of interconnection between sectoral and thematic themes, prioritization and sequencing of policies, and presents different policy response options to countries based on their profile and conditions.

Education: The second is a paper entitled “COVID-19 Education Shocks and Policy Responses”.  I also attach a ppt titled “Plan Edu GP and COVID19 Operational support April 15” that summarizes country policy responses and possible World Bank operational
responses in the three stages of: (i) coping; (ii) managing continuity; and (iii) improvement/acceleration.

Social protection: I also attach a blog by our Global Director for Social Protection on how social protection can help countries cope with COVID-19:

https://blogs.worldbank.org/voices/how-social-protection-can-help-countries-cope-covid-19.  Attached as well is the latest update on Social Protection measures being taken across the globe (titled: “Country SP COVID responses_April17.pdf”).

COVID-19 and the digital agenda: Please further see attached a document (“ICT_Response(Flattening the curve on COVID-19.pdf”) on how Korea responded to a pandemic using information and communication technology.  I believe there is a major opportunity
to use the current crisis for Georgia to fully transition to the digital economy, i.e. to digitize govt. service delivery, embrace the FinTech agenda, as well as e-health agenda.

Support to distressed businesses: A global compendium of reform measures taken by 38 countries on fiscal and regulatory relief being provided in support of distressed SMEs and large corporates, which you can find here (see

interactive map) and on our WB
Finance and Coronavirus (COVID-19) webpage.

COVID-19 and trade: A note (“COVID-19 Trade Watch – April 2020.pdf”) tracking country and industry patterns, the depth of the decline of trade, and the eventual reversal.  Of note is the beginning of a dramatic drop in international trade as a result
of COVID-19. The trade slowdown, initially most evident in China, is increasingly spreading to other regions.

Support to tourism: And finally, here is a paper on the impact and policy responses for the tourism sector during the COVID-19 pandemic.

https://worldbankgroup.sharepoint.com/sites/gge/Documents/COVID-19%20Response%20Documents/200403%20FCI%20Sector%20Note%20-%20Tourism%20and%20COVID%2019%20Key%202%20Pager%20CLEAN%20copy_Martha%20JP%20rev.pdf?deliveryName=DM11151

The OECD has created a useful Country Policy Tracker system that summarizes health, fiscal and social measures.  It is updated daily and includes developing countries as well.
http://www.oecd.org/coronavirus/en/#key-impacts

Kind regards,

Sebastian

Sebastian Molineus

Regional Director for the South Caucasus

Europe and Central Asia

T
+995 (32) 291 6238

M
+995 (577) 78 7821

M
+1 (202) 492-3914

E
[email-masked]

W
www.worldbank.org/en/region/eca

@smolineus

www.linkedin.com/in/molineus/

From: Sebastian-A Molineus

Sent: Friday, April 10, 2020 4:54 PM

To: [email-masked];
[email-masked]

Cc: [email-masked]; Ekaterine Mikabadze <[email-masked]>;
[email-masked]; Evgenij Najdov <[email-masked]>; Lire Ersado <[email-masked]>; Abdulaziz Faghi
<[email-masked]>; Jan Van Bilsen <[email-masked]>

Subject: RE: Our standing WB offer to support the government of Georgia during the COVID-19 crisis

Dear Natia and Ivane –

Please find attached three new World Bank policy notes to help our clients combat the COVID-19 crisis.

The first focuses on the tourism sector and looks at the crisis’ impact on the sector and policy responses.

The second is on revenue administration applications, looking at potential tax administration and customs measures to respond to the crisis.

And the third is an 2-page action plan on public debt management and essentially offers World Bank advisory support on how to finance their fiscal response.

Kind regards,

Sebastian

Sebastian Molineus

Regional Director for the South Caucasus

Europe and Central Asia

T
+995 (32) 291 6238

M
+995 (577) 78 7821

M
+1 (202) 492-3914

E
[email-masked]

W
www.worldbank.org/en/region/eca

@smolineus

www.linkedin.com/in/molineus/

From: Sebastian-A Molineus

Sent: Friday, April 03, 2020 9:37 PM

To: [email-masked];
[email-masked]

Cc: [email-masked];
[email-masked]; Evgenij Najdov <[email-masked]>; Lire Ersado <[email-masked]>; Abdulaziz Faghi <[email-masked]>;
Jan Van Bilsen <[email-masked]>

Subject: Re: Our standing WB offer to support the government of Georgia during the COVID-19 crisis

My last email for the week and over the weekend, I promise, but I did think it important to share this scientific article confirming the effectiveness of surgical face masks (contrary what was initially reported) as it could influence preventive
measures taken by the govt. moving forward.

Respiratory virus shedding in exhaled breath and efficacy of face masks | Nature Medicine

https://www.nature.com/articles/s41591-020-0843-2

Respiratory virus shedding in exhaled breath and efficacy of face masks

·  ,03 April 2020

Nature Medicine (2020)Cite this article

4115 Altmetric

Metrics

Abstract

We identified seasonal human coronaviruses, influenza viruses and rhinoviruses in exhaled breath and coughs of children and adults with acute respiratory illness. Surgical face masks significantly
reduced detection of influenza virus RNA in respiratory droplets and coronavirus RNA in aerosols, with a trend toward reduced detection of coronavirus RNA in respiratory droplets. Our results indicate that surgical face masks could prevent transmission of
human coronaviruses and influenza viruses from symptomatic individuals.

Main

Respiratory virus infections cause a broad and overlapping spectrum of symptoms collectively referred to as acute respiratory virus illnesses (ARIs) or more commonly the ‘common cold’.
Although mostly mild, these ARIs can sometimes cause severe disease and death1.
These viruses spread between humans through direct or indirect contact, respiratory droplets (including larger droplets that fall rapidly near the source as well as coarse aerosols with aerodynamic diameter >5 µm) and fine-particle aerosols (droplets and droplet
nuclei with aerodynamic diameter ≤5 µm)2,3.
Although hand hygiene and use of face masks, primarily targeting contact and respiratory droplet transmission, have been suggested as important mitigation strategies against influenza virus transmission4,
little is known about the relative importance of these modes in the transmission of other common respiratory viruses2,3,5.
Uncertainties similarly apply to the modes of transmission of COVID-19 (refs. 6,7).

Some health authorities recommend that masks be worn by ill individuals to prevent onward transmission (source control)4,8.
Surgical face masks were originally introduced to protect patients from wound infection and contamination from surgeons (the wearer) during surgical procedures, and were later adopted to protect healthcare workers against acquiring infection from their patients.
However, most of the existing evidence on the filtering efficacy of face masks and respirators comes from in vitro experiments with nonbiological particles9,10,
which may not be generalizable to infectious respiratory virus droplets. There is little information on the efficacy of face masks in filtering respiratory viruses and reducing viral release from an individual with respiratory infections8,
and most research has focused on influenza11,12.

Here we aimed to explore the importance of respiratory droplet and aerosol routes of transmission with a particular focus on coronaviruses, influenza viruses and rhinoviruses,
by quantifying the amount of respiratory virus in exhaled breath of participants with medically attended ARIs and determining the potential efficacy of surgical face masks to prevent respiratory virus transmission.

Results

We screened 3,363 individuals in two study phases, ultimately enrolling 246 individuals who provided exhaled breath samples (Extended Data Fig. 1).
Among these 246 participants, 122 (50%) participants were randomized to not wearing a face mask during the first exhaled breath collection and 124 (50%) participants were randomized to wearing a face mask. Overall, 49 (20%) voluntarily provided a second exhaled
breath collection of the alternate type.

Infections by at least one respiratory virus were confirmed by reverse transcription PCR (RT–PCR) in 123 of 246 (50%) participants. Of these 123 participants, 111 (90%)
were infected by human (seasonal) coronavirus (n = 17), influenza virus (n = 43) or rhinovirus (n = 54) (Extended Data Figs. 1 and 2),
including one participant co-infected by both coronavirus and influenza virus and another two participants co-infected by both rhinovirus and influenza virus. These 111 participants were the focus of our analyses.

There were some minor differences in characteristics of the 111 participants with the different viruses (Table 1a).
Overall, 24% of participants had a measured fever ≥37.8 °C, with patients with influenza more than twice as likely than patients infected with coronavirus and rhinovirus to have a measured fever. Coronavirus-infected participants coughed the most with an average
of 17 (s.d. = 30) coughs during the 30-min exhaled breath collection. The profiles of the participants randomized to with-mask versus without-mask groups were similar (Supplementary Table 1).

Table 1a Characteristics of individuals with symptomatic coronavirus, influenza virus or rhinovirus infection

Full size table

We tested viral shedding (in terms of viral copies per sample) in nasal swabs, throat swabs, respiratory droplet samples and aerosol samples and compared the latter two
between samples collected with or without a face mask (Fig. 1). On average, viral shedding was higher
in nasal swabs than in throat swabs for each of coronavirus (median 8.1 log10 virus copies per sample versus 3.9), influenza virus (6.7 versus 4.0)
and rhinovirus (6.8 versus 3.3), respectively. Viral RNA was identified from respiratory droplets and aerosols for all three viruses, including 30%, 26% and 28% of respiratory droplets and 40%, 35% and 56% of aerosols collected while not wearing a face mask,
from coronavirus, influenza virus and rhinovirus-infected participants, respectively (Table 1b). In
particular for coronavirus, we identified OC43 and HKU1 from both respiratory droplets and aerosols, but only identified NL63 from aerosols and not from respiratory droplets (Supplementary Table 2 and
Extended Data Fig. 3).

Fig. 1: Efficacy of surgical face masks in reducing respiratory virus shedding in respiratory droplets and aerosols of symptomatic individuals with coronavirus, influenza
virus or rhinovirus infection.

a–c, Virus copies per sample collected in nasal swab (red), throat swab (blue) and respiratory droplets
collected for 30min while not wearing (dark green) or wearing (light green) a surgical face mask, and aerosols collected for 30min while not wearing (brown) or wearing (orange) a face mask, collected from individuals with acute respiratory symptoms who were
positive for coronavirus (a), influenza virus (b) and rhinovirus (c), as determined by RT–PCR in any samples. Pvalues for mask intervention as predictor of log10 virus
copies per sample in an unadjusted univariate Tobit regression model which allowed for censoring at the lower limit of detection of the RT–PCR assay are shown, with significant differences in bold. For nasal swabs and throat swabs, all infected individuals
were included (coronavirus, n=17; influenza virus, n=43; rhinovirus, n=54). For respiratory droplets and aerosols, numbers of infected individuals who provided exhaled breath samples while not wearing or wearing a surgical face mask, respectively
were: coronavirus (n=10 and 11), influenza virus (n=23 and 28) and rhinovirus (n=36 and 32). A subset of participants provided exhaled breath samples for both mask interventions (coronavirus, n=4; influenza virus, n=8; rhinovirus, n=14).
The box plots indicate the median with the interquartile range (lower and upper hinge) and ±1.5×interquartile range from the first and third quartile (lower and upper whiskers).

Full size image

Table 1b Efficacy of surgical face masks in reducing respiratory virus frequency of detection and viral shedding in respiratory droplets and aerosols of symptomatic
individuals with coronavirus, influenza virus or rhinovirus infection

Full size table

We detected coronavirus in respiratory droplets and aerosols in 3 of 10 (30%) and 4 of 10 (40%) of the samples collected without face masks, respectively, but did not detect
any virus in respiratory droplets or aerosols collected from participants wearing face masks, this difference was significant in aerosols and showed a trend toward reduced detection in respiratory droplets (Table 1b).
For influenza virus, we detected virus in 6 of 23 (26%) and 8 of 23 (35%) of the respiratory droplet and aerosol samples collected without face masks, respectively. There was a significant reduction by wearing face masks to 1 of 27 (4%) in detection of influenza
virus in respiratory droplets, but no significant reduction in detection in aerosols (Table 1b). Moreover,
among the eight participants who had influenza virus detected by RT–PCR from without-mask aerosols, five were tested by viral culture and four were culture-positive. Among the six participants who had influenza virus detected by RT–PCR from with-mask aerosols,
four were tested by viral culture and two were culture-positive. For rhinovirus, there were no significant differences between detection of virus with or without face masks, both in respiratory droplets and in aerosols (Table 1b).
Conclusions were similar in comparisons of viral shedding (Table 1b). In addition, we found a significant
reduction in viral shedding (Supplementary Table 2) in respiratory droplets for OC43 (Extended Data
Fig. 4) and influenza B virus (Extended Data Fig. 5)
and in aerosols for NL63 (Extended Data Fig. 4).

We identified correlations between viral loads in different samples (Extended Data Figs. 6–8)
and some evidence of declines in viral shedding by time since onset for influenza virus but not for coronavirus or rhinovirus (Extended Data Fig. 9).
In univariable analyses of factors associated with detection of respiratory viruses in various sample types, we did not identify significant association in viral shedding with days since symptom onset (Supplementary Table 3)
for respiratory droplets or aerosols (Supplementary Tables 4–6).

A subset of participants (72 of 246, 29%) did not cough at all during at least one exhaled breath collection, including 37 of 147 (25%) during the without-mask and 42 of
148 (28%) during the with-mask breath collection. In the subset for coronavirus (n = 4), we did not detect any virus in respiratory droplets or aerosols from any participants. In the subset for influenza virus (n = 9), we detected virus in aerosols
but not respiratory droplets from one participant. In the subset for rhinovirus (n = 17), we detected virus in respiratory droplets from three participants, and we detected virus in aerosols in five participants.

Discussion

Our results indicate that aerosol transmission is a potential mode of transmission for coronaviruses as well as influenza viruses and rhinoviruses. Published studies detected respiratory
viruses13,14such
as influenza12,15 and
rhinovirus16 from
exhaled breath, and the detection of SARS-CoV17and
MERS-CoV18 from
air samples (without size fractionation) collected from hospitals treating patients with severe acute respiratory syndrome and Middle East respiratory syndrome, but ours demonstrates detection of human seasonal coronaviruses in exhaled breath, including the
detection of OC43 and HKU1 from respiratory droplets and NL63, OC43 and HKU1 from aerosols.

Our findings indicate that surgical masks can efficaciously reduce the emission of influenza virus particles into the environment in respiratory droplets, but not in aerosols12.
Both the previous and current study used a bioaerosol collecting device, the Gesundheit-II (G-II)12,15,19,
to capture exhaled breath particles and differentiated them into two size fractions, where exhaled breath coarse particles >5 μm (respiratory droplets) were collected by impaction with a 5-μm slit inertial Teflon impactor and the remaining fine particles ≤5 μm
(aerosols) were collected by condensation in buffer. We also demonstrated the efficacy of surgical masks to reduce coronavirus detection and viral copies in large respiratory droplets and in aerosols (Table 1b).
This has important implications for control of COVID-19, suggesting that surgical face masks could be used by ill people to reduce onward transmission.

Among the samples collected without a face mask, we found that the majority of participants with influenza virus and coronavirus infection did not shed detectable virus
in respiratory droplets or aerosols, whereas for rhinovirus we detected virus in aerosols in 19 of 34 (56%) participants (compared to 4 of 10 (40%) for influenza and 8 of 23 (35%) for coronavirus). For those who did shed virus in respiratory droplets and aerosols,
viral load in both tended to be low (Fig. 1). Given the high collection efficiency of the G-II (ref. 19)
and given that each exhaled breath collection was conducted for 30 min, this might imply that prolonged close contact would be required for transmission to occur, even if transmission was primarily via aerosols, as has been described for rhinovirus colds20.
Our results also indicate that there could be considerable heterogeneity in contagiousness of individuals with coronavirus and influenza virus infections.

The major limitation of our study was the large proportion of participants with undetectable viral shedding in exhaled breath for each of the viruses studied. We could have
increased the sampling duration beyond 30 min to increase the viral shedding being captured, at the cost of acceptability in some participants. An alternative approach would be to invite participants to perform forced coughs during exhaled breath collection12.
However, it was the aim of our present study to focus on recovering respiratory virus in exhaled breath in a real-life situation and we expected that some individuals during an acute respiratory illness would not cough much or at all. Indeed, we identified
virus RNA in a small number of participants who did not cough at all during the 30-min exhaled breath collection, which would suggest droplet and aerosol routes of transmission are possible from individuals with no obvious signs or symptoms. Another limitation
is that we did not confirm the infectivity of coronavirus or rhinovirus detected in exhaled breath. While the G-II was designed to preserve viability of viruses in aerosols, and in the present study we were able to identify infectious influenza virus in aerosols,
we did not attempt to culture coronavirus or rhinovirus from the corresponding aerosol samples.

Methods

Study design

Participants were recruited year-round from March 2013 through May 2016 in a general outpatient clinic of a private hospital in Hong Kong. As routine practice, clinic staff
screened all individuals attending the clinics for respiratory and any other symptoms regardless of the purpose of the visit at triage. Study staff then approached immediately those who reported at least one of the following symptoms of ARI for further screening:
fever ≥37.8 °C, cough, sore throat, runny nose, headache, myalgia and phlegm. Individuals who reported ≥2 ARI symptoms, within 3 d of illness onset and ≥11 years of age were eligible to participate. After explaining the study to and obtaining informed consent
from the participants, a rapid influenza diagnostic test, the Sofia Influenza A + B Fluorescent Immunoassay Analyzer (cat. no. 20218, Quidel), was used to identify influenza A or B virus infection as an incentive to participate. All participants provided a
nasal swab for the rapid test and an additional nasal swab and a separate throat swab for subsequent virologic confirmation at the laboratory. All participants also completed a questionnaire to record basic information including age, sex, symptom severity,
medication, medical conditions and smoking history. In the first phase of the study from March 2013 to February 2014 (‘Influenza Study’), the result of the rapid test was used to determine eligibility for further participation in the study and exhaled breath
collection, whereas in the second phase of the study from March 2014 to May 2016 (‘Respiratory Virus Study’), the rapid test did not affect eligibility. Eligible participants were then invited to provide an exhaled breath sample for 30 min in the same clinic
visit.

Before exhaled breath collection, each participant was randomly allocated in a 1:1 ratio to either wearing a surgical face mask (cat. no. 62356, Kimberly-Clark) or not during
the collection. To mimic the real-life situation, under observation by the study staff, participants were asked to attach the surgical mask themselves, but instruction on how to wear the mask properly was given when the participant wore the mask incorrectly.
Participants were instructed to breathe as normal during the collection, but (natural) coughing was allowed and the number of coughs was recorded by study staff. Participants were then invited to provide a second exhaled breath sample of the alternate type
(for example if the participant was first assigned to wearing a mask they would then provide a second sample without a mask), but most participants did not agree to stay for a second measurement because of time constraints. Participants were compensated for
each 30-min exhaled breath collection with a supermarket coupon worth approximately US$30 and all participants were gifted a tympanic thermometer worth approximately US$20.

Ethical approval

Written informed consent was obtained from all participants ≥18 years of age and written informed consent was obtained from parents or legal guardians of participants 11–17
years of age in addition to their own written informed consent. The study protocol was approved by the Institutional Review Board of The University of Hong Kong and the Clinical and Research Ethics Committee of Hong Kong Baptist Hospital.

Collection of swabs and exhaled breath particles

Nasal swabs and throat swabs were collected separately, placed in virus transport medium, stored and transported to the laboratory at
2–8 °C and the virus transport medium was aliquoted and stored at −70 °C until further analysis. Exhaled breath particles were captured and differentiated into two size fractions, the coarse fraction
containing particles with aerodynamic diameter >5 μm (referred to here as ‘respiratory droplets’), which included droplets up to approximately 100 µm in diameter and the fine fraction with particles ≤5 μm (referred to here as ‘aerosols’) by the G-II bioaerosol
collecting device12,15,19.
In the G-II device, exhaled breath coarse particles >5 μm were collected by a 5-μm slit inertial Teflon impactor and the remaining fine particles ≤5 μm were condensed and collected into approximately 170 ml of 0.1% BSA/PBS. Both the impactor and the condensate
were stored and transported to the laboratory at 2–8 °C. The virus on the impactor was recovered
into 1 ml and the condensate was concentrated into 2 ml of 0.1% BSA/PBS, aliquoted and stored at −70 °C until further analysis. In a validation study, the G-II was able to recover over 85% of fine particles >0.05 µm in size and had comparable collection efficiency
of influenza virus as the SKC BioSampler19.

Laboratory testing

Samples collected from the two studies were tested at the same time. Nasal swab samples were first tested by a diagnostic-use viral panel, xTAG Respiratory Viral Panel (Abbott
Molecular) to qualitatively detect 12 common respiratory viruses and subtypes including coronaviruses (NL63, OC43, 229E and HKU1), influenza A (nonspecific, H1 and H3) and B viruses, respiratory syncytial virus, parainfluenza virus (types 1–4), adenovirus,
human metapneumovirus and enterovirus/rhinovirus. After one or more of the candidate respiratory viruses was detected by the viral panel from the nasal swab, all the samples from the same participant (nasal swab, throat swab, respiratory droplets and aerosols)
were then tested with RT–PCR specific for the candidate virus(es) for determination of virus concentration in the samples. Infectious influenza virus was identified by viral culture using MDCK cells as described previously21,
whereas viral culture was not performed for coronavirus and rhinovirus.

Statistical analyses

The primary outcome of the study was virus generation rate in tidal breathing of participants infected by different respiratory viruses and the efficacy of face masks in
preventing virus dissemination in exhaled breath, separately considering the respiratory droplets and aerosols. The secondary outcomes were correlation between viral shedding in nose swabs, throat swabs, respiratory droplets and aerosols and factors affecting
viral shedding in respiratory droplets and aerosols.

We identified three groups of respiratory viruses with the highest frequency of infection as identified by RT–PCR, namely coronavirus (including NL63, OC43, HKU1 and 229E),
influenza virus and rhinovirus, for further statistical analyses. We defined viral shedding as log10 virus copies per sample and plotted viral shedding
in each sample (nasal swab, throat swab, respiratory droplets and aerosols); the latter two were stratified by mask intervention. As a proxy for the efficacy of face masks in preventing transmission of respiratory viruses via respiratory droplet and aerosol
routes, we compared the respiratory virus viral shedding in respiratory droplet and aerosol samples between participants wearing face masks or not, by comparing the frequency of detection with a two-sided Fisher’s exact test and by comparing viral load (defined
as log10 virus copies per sample) by an unadjusted univariate Tobit regression model, which allowed for censoring at the lower limit of detection
of the RT–PCR assay. We also used the unadjusted univariate Tobit regression to investigate factors affecting viral shedding in respiratory droplets and aerosols without mask use, for example age, days since symptom onset, previous influenza vaccination, current
medication and number of coughs during exhaled breath collection. We investigated correlations between viral shedding in nasal swab, throat swab, respiratory droplets and aerosols with scatter-plots and calculated the Spearman’s rank correlation coefficient
between any two types of samples. We imputed 0.3 log10 virus copies ml−1 for
undetectable values before transformation to log10 virus copies per sample. All analyses were conducted with R v.3.6.0 (ref. 22)
and the VGAM package v.1.1.1 (ref. 23).

Reporting Summary

Further information on research design is available in the Nature
Research Reporting Summary linked to this article.

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Acknowledgements

This work was supported by the General Research Fund of the University Grants Committee (grant no. 765811), the Health and Medical Research Fund (grant no. 13120592)
and a commissioned grant of the Food and Health Bureau and the Theme-based Research Scheme (project no. T11-705/14-N) of the Research Grants Council of the Hong Kong SAR Government. We acknowledge colleagues including R. O. P. Fung, A. K. W. Li, T. W. Y. Ng,
T. H. C. So, P. Wu and Y. Xie for technical support in preparing and conducting this study and enrolling participants; J. K. M. Chan, S. Y. Ho, Y. Z. Liu and A. Yu for laboratory support; S. Ferguson, W. K. Leung, J. Pantelic, J. Wei and M. Wolfson for technical
support in constructing and maintaining the G-II device; V. J. Fang, L. M. Ho and T. T. K. Lui for setting up the database; and C. W. Y. Cheung, L. F. K. Cheung, P. T. Y. Ching, A. C. H. Lai, D. W. Y. Lam, S. S. Y. Lo, A. S. K. Luk and other colleagues at
the Outpatient Center and Infection Control Team of Hong Kong Baptist Hospital for facilitating this study.

Author information

These authors jointly supervised this work: Donald K. Milton, Benjamin J. Cowling.

Affiliations

WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China

Nancy H. L. Leung

, Daniel K. W. Chu

, Eunice Y. C. Shiu

, Benien J. P. Hau

, Hui-Ling Yen

, Dennis K. M. Ip

, J. S. Malik Peiris

, Wing-Hong Seto

, Gabriel M. Leung

& Benjamin J. Cowling

Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China

Kwok-Hung Chan

Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA

James J. McDevitt

Department of Surgery, Queen Mary Hospital, Hong Kong, China

Benien J. P. Hau

Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China

Yuguo Li

Department of Pathology, Hong Kong Baptist Hospital, Hong Kong, China

Wing-Hong Seto

Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, MD, USA

Donald K. Milton

Contributions

All authors meet the International Committee of Medical Journal Editors criteria for authorship. The study protocol was drafted by N.H.L.L. and B.J.C. Data were collected
by N.H.L.L., E.Y.C.S. and B.J.P.H. Laboratory testing was performed by D.K.W.C. and K.-H.C. Statistical analyses were conducted by N.H.L.L. N.H.L.L. and B.J.C. wrote the first draft of the manuscript, and all authors provided critical review and revision of
the text and approved the final version.

Corresponding author

Correspondence to Benjamin J. Cowling.

Ethics declarations

Competing interests

B.J.C. consults for Roche and Sanofi Pasteur. The authors declare no other competing interests.

Additional information

Peer review information Alison Farrell was the primary editor on this article and managed its editorial process and peer review
in collaboration with the rest of the editorial team.

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional
affiliations.

Extended data

Extended Data Fig. 1

Participant enrolment, randomization of mask intervention and identification of respiratory virus infection.

Extended Data Fig. 2 Weekly number of respiratory virus infections identified by RT-PCR in symptomatic individuals who had provided
exhaled breath samples (respiratory droplets and aerosols) during the study period.

Blue, coronavirus; red, influenza virus; yellow, rhinovirus; green, other respiratory viruses including human metapneumovirus, parainfluenza virus, respiratory syncytial virus and adenovirus;
white, no respiratory virus infection identified.

Extended Data Fig. 3 Respiratory virus shedding in (a) nasal swab, (b) throat swab, (c) respiratory droplets and (d) aerosols
in symptomatic individuals with coronavirus NL63, coronavirus OC43, coronavirus HKU1, influenza A and influenza B virus infection.

For nasal swabs and throat swabs, all infected individuals identified by RT-PCR in any collected samples were included: coronavirus NL63 (n = 8), coronavirus OC43 (n = 5), coronavirus
HKU1 (n = 4), influenza A virus (n = 31) and influenza B virus (n = 14). For respiratory droplets and aerosols, only infected individuals who provided exhaled breath samples while not wearing a surgical face mask were included: coronavirus NL63 (n = 3), coronavirus
OC43 (n = 3), coronavirus HKU1 (n = 4), influenza A virus (n = 19) and influenza B virus (n = 6). The box plots indicate the median with the interquartile range (lower and upper hinge) and ± 1.5 × interquartile range from the first and third quartile (lower
and upper whisker). Dark blue, coronavirus NL63; light blue, coronavirus OC43; brown, coronavirus HKU1; red, influenza A virus; orange, influenza B virus.

Extended Data Fig. 4 Efficacy of surgical face masks in reducing respiratory virus shedding in respiratory droplets and aerosols
of symptomatic individuals with seasonal coronaviruses including (a) coronavirus NL63, (b) coronavirus OC43 and (c) coronavirus HKU1.

The figure shows the virus copies per sample collected in nasal swab (red), throat swab (blue), respiratory droplets collected for 30 min while not wearing (dark green) or wearing (light
green) a surgical face mask and aerosols collected for 30 min while not wearing (brown) or wearing (orange) a face mask, collected from individuals with acute respiratory symptoms who were positive for coronavirus NL63, coronavirus OC43 and coronavirus HKU1
as determined by RT-PCR in any samples. P values for mask intervention as predictor of log10virus copies per sample in an unadjusted univariate
Tobit regression model which allowed for censoring at the lower limit of detection of the RT-PCR assay are shown, with significant differences in bold. For nasal swabs and throat swabs, all infected individuals were included (coronavirus NL63, n = 8; coronavirus
OC43, n = 5; coronavirus HKU1, n = 4). For respiratory droplets and aerosols, numbers of infected individuals who provided exhaled breath samples while not wearing or wearing a surgical face mask, respectively were: coronavirus NL63 (n = 3 and 5), coronavirus
OC43 (n = 3 and 4), coronavirus HKU1 (n = 4 and 2). A subset of participants provided exhaled breath samples for both mask interventions (coronavirus NL63, n = 0; coronavirus OC43, n = 2; coronavirus HKU1, n = 2).

Extended Data Fig. 5 Efficacy of surgical face masks in reducing respiratory virus shedding in respiratory droplets and aerosols
of symptomatic individuals with seasonal influenza viruses including (a) influenza A and (b) influenza B virus.

The figure shows the virus copies per sample collected in nasal swab (red), throat swab (blue), respiratory droplets collected for 30 min while not wearing (dark green) or wearing (light
green) a surgical face mask and aerosols collected for 30 min while not wearing (brown) or wearing (orange) a face mask, collected from individuals with acute respiratory symptoms who were positive for influenza A and influenza B virus as determined by RT-PCR
in any samples. P values for mask intervention as predictor of log10 virus copies per sample in an unadjusted univariate Tobit regression
model which allowed for censoring at the lower limit of detection of the RT-PCR assay are shown, with significant differences in bold. For nasal swabs and throat swabs, all infected individuals were included (influenza A virus, n = 31; influenza B virus, n = 14).
For respiratory droplets and aerosols, numbers of infected individuals who provided exhaled breath samples while not wearing or wearing a surgical face mask, respectively were: influenza A virus (n = 19 and 19), influenza B virus (n = 6 and 10). A subset of
participants provided exhaled breath samples for both mask interventions (influenza A virus, n = 7; influenza B virus, n = 2).

Extended Data Fig. 6 Correlation of coronavirus viral shedding between different samples (nasal swab, throat swab, respiratory
droplets and aerosols) in symptomatic individuals with seasonal coronavirus infection.

For nasal swabs and throat swabs, all infected individuals were included (n = 17). For respiratory droplets and aerosols, only infected individuals who provided exhaled breath samples
while not wearing a surgical face mask were included (n = 10). r, the Spearman’s rank correlation coefficient.

Extended Data Fig. 7 Correlation of influenza viral shedding between different samples (nasal swab, throat swab, respiratory droplets
and aerosols) in symptomatic individuals with seasonal influenza infection.

For nasal swabs and throat swabs, all infected individuals were included (n = 43). For respiratory droplets and aerosols, only infected individuals who provided exhaled breath samples
while not wearing a surgical face mask were included (n = 23). r, the Spearman’s rank correlation coefficient.

Extended Data Fig. 8 Correlation of rhinovirus viral shedding between different samples (nasal swab, throat swab, respiratory
droplets and aerosols) in symptomatic individuals with rhinovirus infection.

For nasal swabs and throat swabs, all infected individuals were included (n = 54). For respiratory droplets and aerosols, only infected individuals who provided exhaled breath samples
while not wearing a surgical face mask were included (n = 36). r, the Spearman’s rank correlation coefficient.

Extended Data Fig. 9 Respiratory virus shedding in respiratory droplets and aerosols stratified by days from symptom onset for
(a) coronavirus, (b) influenza virus or (c) rhinovirus.

The figures shows the virus copies per sample collected in nasal swab (red), throat swab (blue), respiratory droplets (dark green) and aerosols (brown) collected for 30 min while not wearing
a surgical face mask, stratified by the number of days from symptom onset on which the respiratory droplets and aerosols were collected. For nasal swabs and throat swabs, all infected individuals were included (coronavirus, n = 17; influenza virus, n = 43;
rhinovirus, n = 54). For respiratory droplets and aerosols, numbers of infected individuals who provided exhaled breath samples while not wearing or wearing a surgical face mask, respectively were: coronavirus (n = 10 and 11), influenza virus (n = 23 and 28),
rhinovirus (n = 36 and 32). A subset of participants provided exhaled breath samples for both mask interventions (coronavirus, n = 4; influenza virus, n = 8; rhinovirus, n = 14). The box plots indicate the median with the interquartile range (lower and upper
hinge) and ± 1.5 × interquartile range from the first and third quartile (lower and upper whisker).

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Leung, N.H.L., Chu, D.K.W., Shiu, E.Y.C. et al. Respiratory virus shedding in exhaled breath and efficacy of face masks. Nat Med(2020). https://doi.org/10.1038/s41591-020-0843-2

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Published03 April 2020

DOIhttps://doi.org/10.1038/s41591-020-0843-2

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Europe and Central Asia, The World Bank

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Sent from my iPhone

On Apr 3, 2020, at 19:33, Sebastian-A Molineus <[email-masked]> wrote:

 Dear colleagues -

Please find below and attached an update on social protection measures from across the world.

FYI, the number of countries with measures in place is now triple-digit; more cash transfers than ever; COVID-related social assistance is benefiting almost 600 million people;
lots of action in social insurance (mostly paid sick leave) as well as labor markets (largely wage subsidies).

<cid:[email-masked]>

Here are stylized facts to help synthesize current global trends:

Fact #1. As of today, a total of 106 countries have introduced or adapted social protection and jobs programs in response to COVID-19. This is an 26% increase since last week
(when countries were 84), while the number of programs grew by almost 50%, i.e., from 283 to 418. Among classes of interventions, social assistance (non-contributory transfers) keeps being the most widely used (including a total of 241 programs), followed
by actions in social insurance (116) and supply-side labor market interventions (61).

Fact #2. Within social assistance, cash transfer programs are clearly the most widely used intervention by governments: these include 124 programs in 71 countries, with 54 new
initiatives introduced specifically as COVID-19 response in 36 countries. Those 124 programs would increase to 149 if social pensions, public works, childcare support and one-off universal basic income (or helicopter money) are considered. Such overall cash-based
portfolio represents over one-third of total social protection programs (35.6%) (see pie below) and 61.8% of social assistance schemes.

Fact #3. More data points on coverage levels are also starting to emerge, especially in social assistance. A preliminary estimate of the number of beneficiaries specifically
supported via COVID-related introductions, expansions, and adaptations of programs is 594 million. Those beneficiaries include both individuals (for programs like public works) and households (e.g., for conditional cash transfers), pending on how they are
reported. On one hand, such estimate is conservative given that not all programs report coverage (especially planned schemes); on the other hand, the estimate also includes schemes for which programs envisioned administrative adaptations, such as providing
the same level of benefits but paid in a more user-friendly way. Clearly, global coverage levels are largely driven by India, but sizable levels can be observed in several countries, especially in Asia.

Fact #4. In terms of social insurance, paid sick leave is the most frequently-adopted measure, including in countries like Algeria, El Salvador, Finland and Lebanon. Unemployment
benefits are also widely used, including for example in Romania, Russia, and South Africa. Deferring or subsidizing social contributions are observed in Montenegro, Germany and the Netherlands among others.

Fact #5. Labor market interventions are another key way in which governments are providing support to formal and informal sector workers (i.e., we don’t include demand-side actions
on the labor markets). Wage subsidies account for 59% of the global labor market portfolio, with programs being implemented in Jamaica, Kosovo, Malaysia and Thailand. Activation measures (worker trainings) are also being considered inter alia in Bosnia and
Herzegovina, China and Romania.

Fact #6. Compared to last week, programs are less unevenly distributed across regions and country income groups. Importantly, measures are being introduced in low-income countries,
although only on social assistance and insurance. In those contexts, social assistance measures mostly include administrative adaptations, in-kind transfers, school feeding, and utility waivers. As such, there appears to be very limited cash transfer program
expanded or introduced (Tajikistan is one example).

Please find attached additional information. I hope you are able to enjoy a bit of the weekend with your families.

<Country social protection COVID responses_April3.pdf>

Best regards,

Sebastian

Sebastian Molineus

Regional Director for the South Caucasus

Europe and Central Asia, The World Bank

T: +995 (32) 291 30 96

M:+995 (577) 78 78 21

M: +1 (202) 492 3914

www.worldbank.org/en/region/eca

www.linkedin.com/in/molineus

Follow me on Twitter @SMolineus

Sent from my iPad

On Apr 3, 2020, at 17:07, Sebastian-A Molineus <[email-masked]> wrote:

Dear all – I attach for information the Korea case study shared with us by the government of Korea, in case of interest.

Kind regards,

Sebastian

Sebastian Molineus

Regional Director for the South Caucasus

Europe and Central Asia

T
+995 (32) 291 6238

M
+995 (577) 78 7821

M
+1 (202) 492-3914

E
[email-masked]

W
www.worldbank.org/en/region/eca

@smolineus

www.linkedin.com/in/molineus/

From: Sebastian-A Molineus

Sent: Friday, March 27, 2020 7:24 PM

To: [email-masked]; [email-masked]

Cc: [email-masked]; [email-masked]; Evgenij Najdov <[email-masked]>; Lire Ersado <[email-masked]>; Abdulaziz Faghi <[email-masked]>; Jan Van Bilsen <[email-masked]>

Subject: RE: Our standing WB offer to support the government of Georgia during the COVID-19 crisis

Dear Ministers, Dear Ekaterine and Ivane –

Please find attached an updated World Bank paper on Social Protection and Jobs Responses to COVID-19: A Real-Time Review of Country Measures.  I trust you will find this paper useful as you design your social protection policy measures
along with our teams within the framework of the upcoming Fast Track COVID-19 Response Facility that your government has requested.

As usual, we stand ready to support and answer any questions you may have.

Kind regards,

Sebastian

Sebastian Molineus

Regional Director for the South Caucasus

Europe and Central Asia

T
+995 (32) 291 6238

M
+995 (577) 78 7821

M
+1 (202) 492-3914

E
[email-masked]

W
www.worldbank.org/en/region/eca

@smolineus

www.linkedin.com/in/molineus/

From: Sebastian-A Molineus

Sent: Thursday, March 26, 2020 7:12 PM

To: [email-masked];
[email-masked];
[email-masked]; [email-masked]

Cc: [email-masked];
[email-masked];
[email-masked]; [email-masked]; Evgenij Najdov <[email-masked]>; Lire Ersado <[email-masked]>; Abdulaziz Faghi
<[email-masked]>; Jan Van Bilsen <[email-masked]>

Subject: RE: Our standing WB offer to support the government of Georgia during the COVID-19 crisis

Dear colleagues –

Please find attached a note on ‘Managing the Employment Impacts of the COVID-19 Crisis’, produced by the World Bank Jobs Group. It reviews a variety of available policy options in a succinct and practical manner, and I hope you find it
useful and timely.

As always, please let me know if you have any questions or would like for us to organize a follow-up discussion with our World Bank experts.

Thank you and kind regards,

Sebastian

Sebastian Molineus

Regional Director for the South Caucasus

Europe and Central Asia

T
+995 (32) 291 6238

M
+995 (577) 78 7821

M
+1 (202) 492-3914

E
[email-masked]

W
www.worldbank.org/en/region/eca

@smolineus

www.linkedin.com/in/molineus/

From: Sebastian-A Molineus

Sent: Tuesday, March 24, 2020 6:27 PM

To: [email-masked];
[email-masked];
[email-masked]; [email-masked]

Cc: [email-masked];
[email-masked];
[email-masked]; Evgenij Najdov <[email-masked]>; Lire Ersado <[email-masked]>; Abdulaziz Faghi <[email-masked]>;
Jan Van Bilsen <[email-masked]>;
[email-masked]

Subject: RE: Our standing WB offer to support the government of Georgia during the COVID-19 crisis

Dear colleagues –

FYI, I am attaching two scientific articles from Harvard University and ISI/ GISC on the effectiveness of social distancing strategies, as well as two World Bank papers, the first of which looks at the lessons-learned from Italy’s COVID-19
response and the second reviewing Global Social Protection Responses to COVID-19, which I know you are contemplating as we speak.  I have summarized key take-aways below:

https://dash.harvard.edu/handle/1/42638988: The SARS-CoV-2 pandemic is straining healthcare resources worldwide, prompting social distancing measures to reduce transmission intensity. The amount
of social distancing needed to curb the SARS-CoV-2 epidemic in the context of seasonally varying transmission remains unclear. Using a mathematical model, we assessed that one-time interventions will be insufficient to maintain COVID-19 prevalence within the
critical care capacity of the United States. Seasonal variation in transmission will facilitate epidemic control during the summer months but could lead to an intense resurgence in the autumn. Intermittent distancing measures can maintain control of the epidemic,
but without other interventions, these measures may be necessary into 2022. Increasing critical care capacity could reduce the duration of the SARS-CoV-2 epidemic while ensuring that critically ill patients receive appropriate care.

https://covid-19-sds.github.io/assets/pdfs/Preliminary_Report_Effectiveness_of_social_distance_strategies_COVID-19.pdf:
Key findings 1. School closures do not have a major impact on controlling the epidemic, despite closing them, infections keep occurring within the households and the community layers. 2. Passive social distance strategies are not enough to contain the epidemic,
indicating that active strategies need to be established. For instance, large scale testing, remote symptoms monitoring, isolation and contact tracing. 3. School closures and self-distancing at 90% of adoption is a feasible strategy for minimizing the effects
of the epidemic, but only if they are applied for a long period of time. 4. A full confinement is not feasible and will not solve the problem, without active measures in place after the confinement, since there would be a new outbreak. 5. If high resolution
mobility data is available, our data-driven approach with real world data can be easily replicated for new cities or countries to measure the impact of social distance strategies and the epidemic.

Early lessons-learned from Italy: In response to previous epidemics of SARS and MERS, China, Singapore, and South Korea overhauled their emergency systems and strengthened public health and disease surveillance response systems, which enabled a swift
response to the COVID-19 pandemics. Different countries worldwide have different levels of preparedness and have adopted different measures to combat COVID-19 pandemic, offering vital insight into the response. Lack of swift disease detection and containment
measures can lead to overwhelmed health systems swiftly, and exceeding healthcare capacity can further exacerbate the community spread of SARS-CoV-2/COVID-19.  Timely disease control measures need to be accompanied with surge capacity to curb the exponential
spread of COVID-19. The evidence suggests that travel restrictions only work if coupled with rapid testing, physical distancing, isolation, infection prevention and Control in HCWs etc. to break the chain of transmission.  In a globalized world where epidemics
and pandemics are increasingly common, pandemic surge planning using the 4 S framework (Space, Stuff, Staff, and System) can enable bolstered surge response. The proposed recommendations contain short, medium, and long-term measures to operationalize surge
response to COVID-19 in Italy; including short-term measures to scale up surge response using the 4 S framework; medium and long-term measures of gap analysis for legislative and institutional reforms, and health system strengthening respectively.

A Global Review of Social Protection Responses to COVID-19: As of March 20, 2020, a total of 45 countries have introduced, adapted or expanded social protection programs in response to COVID-19.
The most widely used measures include: cash transfers (30 programs), followed by wage subsidies (11), subsidized sick leave (10), and various forms of subsidized social security contributions and unemployment insurance.  A total of 13 new cash transfer programs
have been introduced, like for example in Bolivia, India, Iran and Peru.  A universal, one-off cash payment to all citizens will occur in Hong-Kong and Singapore.  New in-kind schemes have also been launched, such as food vouchers in Taiwan and Seattle in
the United States. Countries are adapting existing social assistance programs in various ways, by for instance: (i) anticipating payments of future cash transfer programs (Colombia and Indonesia); (ii) ensuring additional payments, often on a one-off basis
(e.g., Argentina, Armenia, Australia, Turkey); (iii) providing more generous benefit levels (e.g., China); (iv) increasing the coverage of existing cash schemes (e.g., Brazil) and public works (Uzbekistan); (v) enhancing agility by suspending conditionalities
in the UK and Italy; and (vi) providing innovative design solutions, such as school feeding programs delivering food directly to children’s homes or nearby centers (Jamaica and India’s Kerala state) or adapting their financing (Japan).  Income support in the
form of childcare vouchers or allowances were provided in Italy, Poland and South Korea.  Other social assistance programs include support for homeless populations as planned in Spain; utility subsidies waiving fees for basic services are present in El Salvador;
and wavers for loans and other financial obligations (e.g., Bolivia).  Many countries provide cash benefits to crisis-affected self-employed workers (e.g., Ireland, Portugal, New Zealand) and those in the informal sector (India). Some countries (e.g., Netherland)
are reducing work time among the wage employed, combined with paid sick leave. Sweden is reducing the administrative time required for sick-leave payments, while Switzerland is doing so for the unemployment insurance process.  Delivery innovations are also
emerging in Jordan (new cash program using same registration form of existing schemes), Japan (uploading transfers on phones), and Romania (enhanced electronic processes for benefits).

I hope you find these useful.

Kind regards,

Sebastian

Sebastian Molineus

Regional Director for the South Caucasus

Europe and Central Asia

T
+995 (32) 291 6238

M
+995 (577) 78 7821

M
+1 (202) 492-3914

E
[email-masked]

W
www.worldbank.org/en/region/eca

@smolineus

www.linkedin.com/in/molineus/

From: Sebastian-A Molineus

Sent: Sunday, March 22, 2020 12:31 PM

To: [email-masked];
[email-masked];
[email-masked]

Cc: [email-masked];
[email-masked];
[email-masked]; Evgenij Najdov <[email-masked]>; Lire Ersado <[email-masked]>; Abdulaziz Faghi <[email-masked]>;
Jan Van Bilsen <[email-masked]>

Subject: RE: Our standing WB offer to support the government of Georgia during the COVID-19 crisis

Dear Ministers and Governor, Dear Natia, Ivane, and Koba -

please find attached a global compendium of financial sector policy measures relevant to combatting the economic fall-out from COVID-19.  The document remains a work in progress and is in draft form, but given the speed at which everything
is evolving I’d rather share this document with you sooner than later.  I will of course continue to share relevant updates with you.  I also share with you a set of broader policy measures undertaken by the EU member countries, again for info.

COVID-19 outbreak: Classification of Policy Measures Related to the Financial Sector

Draft March 18, 2020

Monetary and liquidity measures

Easing of policy rates

Liquidity support (e.g., OMO/repo, standing facilities, FX, minimum reserve requirements, collateral)

Credit easing (e.g. purchases of corporate, government, MBS paper; outright support to SMEs)

Easing Emergency Liquidity Assistance (e.g., loosening of collateral criteria)

Financial institution measures

Prudential and integrity

Easing/draw down of capital buffers (e.g., counter-cyclical, capital conservation)

Easing limits on large exposures

Easing of liquidity requirements (in foreign and local currency)

Forbearance of NPL classification, past due classification

Suspension of accounting standards (e.g. IFRS 9) or provisioning rules

Lower certain risks weights (e.g., loans with government guarantees)

Easing of macro-prudential measures (e.g., LTVs, DTIs)

Restrictions on dividend payments

Limit foreign exposures of banks and non-bank financial institutions

Ensure compliance of critical conduct and integrity rules to mitigate market abuse

Support for borrowers in affected sectors (e.g., SMEs, tourism, exporters)

Encourage private institutions to provide short-term cash support, waive fees and penalties, etc.

Moratorium on repayments, incl. mortgages (e.g., missed payments added to principal)

Support targeted restructuring of loans

State (partial) guarantees on loans

State subsidies on borrowers’ repayments

State loans to affected companies, sectors (e.g., through state banks or C)

Crisis management

State guarantees on bank liabilities (e.g., deposit guarantees to avert runs)

Freeze on deposit withdrawals

Freeze on withdrawal of open-ended funds

Capital injections, bailouts, bail-ins, and nationalization

Additional (backstop) funding to deposit guarantee schemes

Other measures

Intensification of industry consultation, monitoring of large companies, and key markets

Review business continuity and disaster recovery plans

Review of supervisory reporting requirements and methods as staff cannot access systems

Closing of bank branches and ATMs to prevent COVID-19 spread

Stimulate use of digital payments to prevent COVID-19 spread

Review regulations (KYC) to allow for remote interactions (e.g. refinancing mortgages, SME loans)

Financial markets measures

Market support

FX market interventions by Central Bank

FX swap lines with other Central Banks

Outright asset purchases (e.g., securities of affected companies, sectors)

Market intervention

Halting of trading, bans on (naked) short selling

Temporary restrictions on cross-border capital (out)flows

Public Debt Management measures

Establish basis for decision-making and developing communications strategy

Identify funding from other sources to reduce pressure on traditional wholesale market borrowing

Adapt the funding program to shifts in the demand for government paper

Ensure minimal functionality in the primary and secondary markets

Kind regards,

Sebastian

Sebastian Molineus

Regional Director for the South Caucasus

<20200321_Korea_Response.pdf>