Saturday, July 04, 2020

ECDC: Rapid Risk Assessment On Resurgence Of COVID-19 Cases In EU/EAA


Although most countries in the EU/EEA and the UK saw their peaks of COVID-19 transmission in the late spring - and are currently reporting far lower levels of the disease - a significant number have recently reported a resurgence of the virus.  

In Mid-June Germany saw a spike in cases, causing their estimated reproduction numbers (R-value and 7-day R-value) to increase temporarily above 2.0 (see Germany: While Daily Cases Remain Low RKI Monitoring Rising R0).  

While Germany's R0 has since dropped below 1.0, this is a reminder of  just how fragile gains against the virus can be, as long as SARS-CoV-2 continues to circulate in humans.  Yesterday the ECDC published an updated RRA (Rapid Risk Assessment) on the virus, along with number of new, or revised guidance documents.

First the Executive Summary for the RRA, followed by links to the other reports.

Risk assessment
2 Jul 2020

Since 31 December 2019 and as of 30 June 2020, 10 273 001 cases of coronavirus disease 2019 (COVID-19) have been reported worldwide, including 505 295 deaths. EU/EEA countries and the UK have reported 1 556 709 cases (15 % of all cases), including 176 800 deaths (35% of all deaths), while EU candidate and potential candidate countries reported 229 112 cases (2% of all cases), including 5 988 deaths (1% of all deaths).

Executive summary

The COVID-19 pandemic is posing an unprecedented threat to EU/EEA countries and the UK as well as countries worldwide, many of which have been experiencing widespread transmission of the virus in the community for several months. While decreasing trends in disease incidence are being observed in Europe overall (12% decrease in 14-day incidence of reported cases between 16 and 30 June), there is still community transmission reported in most EU/EEA countries, the UK and EU candidate and potential candidate countries. Additionally, some countries are reporting a resurgence of observed cases or large localised outbreaks.

The reasons behind this apparent increase in the number or resurgence of cases observed in these countries vary. The increase in the number of cases may reflect changes in case ascertainment (e.g. increasing testing, changes in the case definition) that does not necessarily indicate increased rates of transmission, or may reflect genuine increases in transmission (e.g. associated with the easing of non-pharmaceutical interventions (NPI), large localised outbreaks), or may be due to importation of cases. Some of the observed increases, particularly in countries with a small population, are associated with just a few additional new cases. Therefore, information must be interpreted with caution.
Risk assessment

In this risk assessment, ECDC is assessing the risks associated with these reported increases of incident cases in some countries.

Currently, the risk, determined by a combination of the probability of an event occurring and of its consequences (impact) to individuals or the population, is assessed as follows:
  • The overall risk of COVID-19 in countries reporting an increase in incident COVID-19 cases and for which there is, or may shortly be, substantial ongoing community transmission and/or within which appropriate physical distancing measures are not taken, is currently considered moderate for the general population (very high probability of infection and low impact of disease) and very high for populations with defined factors associated with elevated risk for COVID-19 (very high probability of infection and very high impact of disease).
  • Provided that the increases are not merely reflecting a change in the surveillance strategy or artefacts due to small number calculations; the overall risk of COVID-19 transmission further rising in these countries with observed increase of COVID-19 incidence is considered high (very high probability of further increase and moderate impact of a further increase) if no appropriate monitoring systems and capacities for extensive testing and contact tracing are in place, and if NPIs are eased when there is still ongoing community transmission.
Options for response

In order to respond to these risks, the following measures continue to be essential to maintain a reduced level of transmission and avoid resurgence:

  • A robust monitoring framework to closely monitor the epidemiological situation, rapidly detect increased transmission, assess the impact of the interventions in place and avoid a resurgence of COVID-19.
  • An expanded testing strategy aimed at comprehensive testing of all individuals displaying symptoms compatible with COVID-19, independent from their country of origin or residency.
  • 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.
  • Prompt identification and investigation of clusters/outbreaks associated with specific settings, with implementation of tailored control and prevention measures to minimise onward spread to others in the setting and to the wider community.
  • Long-term sustainable implementation of essential NPIs, irrespective of transmission rates, and the ability to amend strategies rapidly in response to indications of increased transmission, if appropriate, only restricting those to subnational areas.
  • A strong risk communication strategy should remind citizens that the pandemic is not over.
National authorities should consider carefully analysing every increase in incidence to assess whether these are associated with genuine increases in transmission and whether these involve populations with defined factors associated with elevated risk for COVID-19, including the residents of long-term care facilities (LTCFs). Identifying possible outbreaks, other foci of transmission, or sustained community transmission due to the easing of the NPIs imposed in previous months is essential to control such increases in incidence and implement tailored control measures aimed at limiting population mobility and/or reducing exposure.

ECDC does not consider travel restrictions within and to the Schengen area as an efficient way to reduce transmission within the EU since community transmission is already taking place in the EU/EEA and data from The European Surveillance System (TESSy) show that, in June 2020, only 3% of confirmed cases were likely infected in a country different from the reporting country.

In addition to the above RRA, the ECDC has recently published the following COVID-19 technical reports and guidance:

Guidance on the provision of support for medically and socially vulnerable populations in EU/EEA countries and the United Kingdom during the COVID-19 pandemic
Technical report - 3 Jul 2020

Infection prevention and control and surveillance for coronavirus disease (COVID-19) in prisons in EU/EEA countries and the UK
Technical report - 3 Jul 2020

Infection prevention and control and preparedness for COVID-19 in healthcare settings - fourth update
Technical report - 3 Jul 2020

Use of gloves in healthcare and non-healthcare settings in the context of the COVID 19 pandemic
Technical report - 2 Jul 2020

COVID-19 Aviation Health Safety Protocol: Guidance for the management of airline passengers in relation to the COVID-19 pandemic
Technical guidance - 1 Jul 2020