Rapid Risk Assessment: Coronavirus disease 2019 (COVID-19) in the EU/EEA and the UK– ninth update
Since 31 December 2019 and as of 22 April 2020, approximately 2.5 million (2 524 812) cases of COVID-19 have been reported worldwide and 177 780 deaths. Of these, 988 241 cases were reported by EU/EEA countries and the UK, including 105 064 deaths.
The COVID-19 pandemic is posing an unprecedented threat to EU/EEA countries and the UK, which have been experiencing widespread transmission of the virus in the community for several weeks. In addition, there has been an increasing number of reports of COVID-19 outbreaks in long-term care homes across Europe with high associated mortality, highlighting the extreme vulnerability of the elderly in this setting.
The absence of an effective treatment or a vaccine combined with an exponential growth in infections from late February, led many countries to implement non-pharmaceutical interventions such as ‘stay-at-home’ policies (recommended or enforced) alongside other community and physical distancing measures such as the cancellation of mass gatherings, closure of educational institutions and public spaces. This approach has collectively reduced transmission and the 14-day incidence in the EU/EEA and the UK overall has declined by 18% since 8 April. In 20 EU/EEA countries, it appears that the initial wave of transmission has passed its peak, with a decline in the number of newly reported cases.
Although this decline has been observed, these measures are highly disruptive to society, both economically and socially. This is why there is significant interest in defining a sound approach to adjusting the measures and phasing out ‘stay-at-home’ policies. However, lifting measures too quickly, without appropriate monitoring and health system capacity in place, may cause a sudden resurgence of sustained community transmission.
The question is therefore how Member States can minimise the impact of COVID-19 on healthcare systems and citizen’s health while restarting economic and social activities. The Joint European Roadmap towards lifting COVID-19 containment measures addresses this question by providing a framework for a comprehensive economic and social recovery plan for the EU, with public health actions at its core.
The overall aim of this rapid risk assessment is to provide the European Commission and Member States with a set of public health objectives and considerations for epidemiological criteria, indicators and accompanying measures, supporting the implementation of this roadmap based on the available scientific evidence:
- Public health objectives
- Reduce morbidity, severe disease and mortality in the population through proportionate non-medical countermeasures, with emphasis on protecting vulnerable (high-risk) groups, until effective vaccines, treatments and medicines become available.
- Limit and control virus circulation and transmission in the general population now (flattening the curve) and for the years to come to maintain the number of new SARS-CoV-2 infections at manageable levels for the healthcare system, and possibly allowing for gradual acquisition of population immunity.
- A robust surveillance strategybased on enhanced testing, whichthoroughly and continuously monitors the panemic by gathering comparable data among Member States, monitors the intensity and geographical spread, detects nosocomial outbreaks, identifies and monitors changes in risk groups, provides information about age-specific population immunity, measures the impact on healthcare systems, monitors viral changes and measures the impact of mitigation and physical distancing measures (and their adjustments) through appropriate epidemiological indicators and criteria.
- An expanded testing capacity and harmonised testing methodologies for the purpose of epidemiological surveillance, early detection and isolation of cases, clinical management, contact tracing, protecting risk groups, assessing population immunity, return-to-work strategies. This includes alignment of testing methodologies, development and ramping up of sustained COVID-19 diagnostic capacity, set-up of adequate testing schemes, validation and rollout of serological testing.
- A framework for contact tracing, based on extensive testing, active case finding, early detection of cases, isolation of cases, quarantine and follow-up of contacts, possibly supported by electronic tools and applications.
- Sufficient healthcare capacity and resilience, including recovered general capacity (not related to COVID-19) and sufficient hospital and intensive care unit (ICU) beds. Monitoring and estimating resource-needs is crucial to ensure that healthcare systems have the capacity to respond to a new surge in cases. Prioritisation should be given to build capacities related to medical, IPC, laboratory and contact tracing equipment as well as human resources.
- An assessment of the response to COVID-19 so far, to identify best practices and lessons learned that can in turn strengthen future response measures. After-action reviews (AARs) and in-action reviews (IARs) can be conducted to assess both capabilities and capacities for the implementation of response strategies.
- A strong risk communication strategy to inform and engage the public and vulnerable groups explaining the rationale behind phasing out ‘stay-at-home’ policies and adjustment of community measures.
- In the present situation, where several countries are still experiencing sustained community transmission and other countries are planning to ease community-level physical distancing measures, the risk assessment will consider the following questions:
- What is the risk, as of 22 April 2020, of severe disease associated with SARS-CoV-2 infection in the general population in the EU/EEA and UK?
- What is the risk, as of 22 April 2020, of severe disease associated with SARS-CoV-2 infection in populations with defined factors associated with elevated risk for COVID-19 in the EU/EEA and UK?
- What is the risk of resurgence of sustained community transmission in the EU/EEA and the UK in the coming weeks, as a consequence of phasing out ‘stay-at-home’ policies and adjusting community level physical distancing measures without appropriate systems and capacities in place?
What is new in this update?
- Updated data on the epidemiological situation in the EU/EEA and the UK.
- Updated data on disease and case severity from Europe.
- Updated data on vulnerable populations (e.g. residents in long-term care facilities), immunity and immune responses.
- First available data on population-based seroepidemiological studies.
- Current risk of severe disease associated with COVID-19 in the EU/EEA and UK for the general population and for vulnerable populations.
- Current risk of resurgence of community transmission of COVID-19 in the EU/EEA and the UK in the coming weeks, as a consequence of phasing out ‘stay-at-home’ policies and adjusting community level physical distancing measures without appropriate systems and capacities in place.
- Updated response measures in place in the EU/EEA and the UK.
- Updated information on approaches to scale-up contact tracing.
- Updated information and EU actions on COVID-19 test performance and expanded testing.
- Practical considerations for phasing out of the ‘stay-at-home’ policies and adjusting physical distancing measures.