Risk assessment on COVID-19, 25 March 2020

Risk assessment

What is the risk of severe disease associated with COVID-19 for the EU/EEA and the UK (as of 25 March 2020)?

The risk of severe disease associated with COVID-19 for people in the EU/EEA and UK is currently considered moderate for the general population and very high for older adults and individuals with chronic underlying conditions.

This assessment is based on the following factors:

  • COVID-19 cases have been reported in all EU/EEA countries and the UK. The overall 14-day cumulative incidence rate for the EU/EEA and the UK has increased from 3.3 cases per 100 000 population on 11 March to 36.1 cases per 100 000 population on 25 March 2020. There is a growing number of cases in many countries without epidemiological links to explain the source of transmission. Based on the predicted development of the 14-day cumulative notification rate, similar levels to those seen in Hubei providence are expected to be seen in all EU/EEA countries and the UK in a few days to a few weeks. Although uncertainty remains about the extent to which the prevention and control measures introduced may slow the speed of transmission, the probability of further continued transmission in the EU/EEA and the UK remains very high.
  • The evidence from analyses of cases in China is that the disease is mild (i.e. non-pneumonia or mild pneumonia) in about 80% of cases; most cases recover, 14% develop severe disease, and 6% experience critical illness. Recent data from EU/EEA countries indicate that 30% of cases are hospitalised, and 4% require critical care. Severe illness and death is more common among the elderly and those with other chronic underlying conditions. These risk groups account for the majority of severe disease and fatalities to date. Mitigation measures to slow transmission have been introduced at different points in the epidemic and at varying intensities across EU/EEA countries and the UK. The effect of these measures in slowing the transmission of COVID-19 in the general population more broadly, and in vulnerable populations of older adults and individuals with chronic underlying conditions specifically, is not yet possible to evaluate. Once infected, no specific treatment for COVID-19 exists, however supportive therapy, if healthcare capacity for this exists, can improve outcomes. In sum, the impact of COVID-19, if acquired, is assessed as moderate for the general population and as very high for elderly and individuals with chronic underlying conditions.

What is the risk of occurrence of widespread national community transmission of COVID-19 in the EU/EEA and the UK in the coming weeks?

The risk of occurrence of widespread national community transmission of COVID-19 in the EU/EEA and the UK in the coming weeks is moderate if effective mitigation measures are in place, and very high if insufficient mitigation measures are in place.

This assessment is based on the following factors:

  • There are rapidly growing numbers of cases in many countries, and many countries in Europe have already reported nation-wide community transmission. Mitigation measures to slow down transmission have been introduced at different points in the epidemic and at varying intensities across EU/EEA countries and the UK. The effect of these measures in slowing the transmission of the virus in the general population and in vulnerable populations is not yet possible to evaluate, but it is known the virus spreads very quickly in the absence of effective mitigation measures. Based on the high transmissibility of the virus and the continued increase in the notification rate in all EU/EEA countries, the probability of occurrence of widespread national community transmission is considered moderate if effective mitigation measures are in place, and very high in the absence of effective mitigation measures. If mitigation measures are lifted suddenly and too early, a resurgence of cases is likely.
  • The impact of national community transmission would be high, especially if healthcare capacity is exceeded or if hospitals are affected and a large number of healthcare workers need to be isolated or become infected. The impact on vulnerable groups would be very high, in particular for the elderly.

What is the risk of healthcare system capacity being exceeded in the EU/EEA and the UK in the coming weeks?

The risk of healthcare system capacity being exceeded in the EU/EEA and the UK in the coming weeks is considered high.

This assessment is based on the following factors:

  • Analyses carried out by ECDC indicate that if the pandemic progresses remains on its current course without strong countermeasures and surge capacity enacted, there is high probability that many EU/EEA countries will experience demands that far exceed currently available ICU capacity. Furthermore, healthcare staff is under pressure and resources are strained across all EU/EEA countries; there have been reports of additional strain or shortages in the following areas: ventilator availability; sampling material and laboratory materials affecting diagnostic capacity for COVID-19 testing (which also affects other laboratory services); contact tracing; surveillance; risk communication; personal protective equipment; shortages of staff and space due to increased needs for triage and isolation of suspected cases. Although the influenza season has peaked in all EU/EEA countries, some healthcare systems may still be under pressure from residual and continued severe influenza cases.
  • Sub-regions of Italy, France, the Netherlands and Spain have already reported healthcare system saturation due to very high patient loads requiring intensive care. The increased pressure caused by COVID-19 on many EU/EEA health system is dependent on the level of preparedness and surge capacity that a given country or area has implemented or can implement quickly. If incidence increases quickly and if additional surge capacity for resources, staff and hospital beds are not ensured, the impact of COVID-19 will be very high and likely result in considerable additional morbidity and mortality in COVID-19 cases. This impact will be mostly concentrated in vulnerable populations of elderly and persons with chronic underlying conditions. Already stretched capacity would be further exacerbated if substantial numbers of healthcare workers became infected with the virus.

 

On 25 March 2020, the European Centre for Disease Control and Prevention (ECDC) updated its rapid risk assessment on the novel coronavirus situation in Europe.

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Rapid risk assessment: Coronavirus disease 2019 (COVID-19) pandemic: increased transmission in the EU/EEA and the UK – seventh update

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On 31 December 2019, a cluster of pneumonia cases of unknown aetiology was reported in Wuhan, Hubei Province, China. On 9 January 2020, China CDC reported a novel coronavirus as the causative agent of this outbreak, coronavirus disease 2019 (COVID-19).

Previous risk assessments

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Rapid risk assessment: Coronavirus disease 2019 (COVID-19) pandemic: increased transmission in the EU/EEA and the UK – seventh update

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