Risk assessment on COVID-19, 11 June 2020

Risk assessment

What is the risk of COVID-19 to the general population as of 10 June 2020 in the EU/EEA and UK?

The risk of COVID 19 in the general population of the EU/EEA and the UK is currently assessed as:

Low in areas where community transmission has been reduced and/or maintained at low levels and where there is extensive testing showing very low detection rates.

Moderate in areas where there is substantial ongoing community transmission and where appropriate physical distancing measures are not in place.

This assessment is based on the information below:

Decreasing trends in disease incidence are observed and sustained in almost all Member States, but several are still reporting ongoing community transmission:

  • As of 10 June, 29 EU/EEA countries and the UK had a decreasing 14-day incidence, while the 14-day incidence was at the highest level yet observed in two countries (Poland and Sweden).
  •  Twenty-eight countries are reporting a current 14-day incidence below 20 cases per 100 000 population. In two countries (Portugal and the United Kingdom) the current 14-day incidence remains at a rate between 20 and 100 cases per 100 000 population. In one country (Sweden) the current 14-day incidence is above 100 cases per 100 000 population.
  • There remains uncertainty as to the extent of viral circulation as there is limited information available on the proportion of community transmission that occurs outside of known transmission chains and/or due to importation across countries.

The implementation of robust response measures in the EU was temporarily associated with an observed decrease in incidence. Although the composition and intensity of implementation varied, all EU/EEA countries and the UK introduced a range of non-pharmaceutical interventions (recommended or enforced – refer to Annex 4). While uncertainty remains about the extent to which the combination and intensity of these measures had an impact on transmission, such measures appear to have been associated, at least temporarily, with decreases in the number of newly reported cases.

In summary, the probability of infection with SARS-CoV-2 for the general population ranges from low (in areas where community transmission has been reduced and/or maintained at low levels and where there is extensive testing, showing very low detection rates) to very high (in areas where appropriate physical distancing measures are not in place and where community transmission is still high).

While the majority of cases of COVID-19 have a mild course of illness, the analysis of data from TESSy shows that the risk of hospitalisation increases rapidly with age, from as early as 30 years, and that the risk of death increases from the age of 50 years, although the majority of hospitalisations and deaths are among the oldest age groups. Older males are particularly affected, being more likely than females of the same age to be hospitalised, require ICU/respiratory support, or die. All-cause excess mortality from EuroMOMO, particularly at this time when competing drivers (influenza and high/low temperatures) are largely absent, shows considerable excess mortality in multiple countries, affecting both the 15−64 and 65+ years age groups in the pooled analysis. Once infected, no specific treatment for COVID-19 exists, however early supportive therapy may improve outcomes. There are ongoing trials that have demonstrated some evidence for limited reduction of symptom duration. There is evidence that since the start of the pandemic, case management, supportive treatment and care has improved.

Overall, the impact of COVID-19 is assessed as moderate for the general population.

What is the risk of COVID-19 to the population with defined factors associated with severe disease outcome as of 10 June 2020 in the EU/EEA and UK?

The risk of COVID 19 to the population with defined factors associated with severe disease outcome is currently assessed as:

Moderate in areas where community transmission has been reduced and/or maintained at low levels and where there is extensive testing showing very low detection rates.

Very high in areas where there is substantial ongoing community transmission and where appropriate physical distancing measures are not in place.

This assessment was based on the information below:

  •  The probability of infection in the different areas has been assessed above and is the same for populations with defined factors associated with severe disease outcome: from low to very high.
  •  Analysis of TESSy data shows that persons over 65 years of age and/or with underlying health conditions infected with COVID-19 are at increased risk of severe illness and death compared with younger individuals.
  • Long-term care facilities (LTCFs), which commonly house the elderly and the frail, have been heavily affected by COVID-19. The disease spreads rapidly on introduction, causing high morbidity in residents, commonly with a case fatality of over 25%. LTCFs were the focus of over half of the fatal COVID-19 cases in several EU/EEA countries and the UK. In summary, the impact of COVID-19 is assessed as very high in the population with defined factors associated with severe disease outcome.

What is the risk of COVID-19 incidence rising to levels that require stricter response measures, as a consequence of lifting/adjusting community level physical distancing measures?

The risk of COVID-19 incidence rising to a level that may require the re-introduction of stricter control measures is currently assessed as:

Moderate if measures are phased out gradually, when only sporadic or cluster transmission is reported, and when appropriate monitoring systems and capacities for extensive testing and contact tracing are in place.

High if measures are phased out when there is still ongoing community transmission, and no appropriate monitoring systems and capacities for extensive testing and contact tracing are in place.

This assessment was based on the information below:

  •  The implementation of robust response measures in EU/EEA countries and the UK was temporarily associated with a decrease in incidence.
  • In the few weeks since the phase-out of some of the response measures, no rapid or major increase in incidence has been observed. Although the composition and intensity of implementation vary, all EU/EEA countries and the UK have introduced a range of non-pharmaceutical interventions to reduce transmission (recommended or enforced).
  • In addition to the implemented response measures, other factors may have contributed to the observed decrease in incidence including seasonality, self-awareness of the population in disease prevention and adherence to measures implemented by governments, a better application of infection prevention and control measures in the community and healthcare settings, and an increase in the offer of testing for exposed and/or symptomatic individuals.
  • The decrease in incidence at national level may hide a level of heterogeneity in disease incidence at subnational level.
  • While decreasing trends in disease incidence are observed, Member States are still reporting community transmission.

The information available from sero-epidemiological studies provides an indication that the population immunity is still low (<10%), therefore there is still a risk that susceptible individuals may become infected.

Even though no major increases in disease incidence have been observed in the weeks since the phase-out of non-pharmaceutical interventions began, an associated upsurge may still be anticipated. However, the reestablishment of transmission chains and larger clusters would take a few generations of infection.

The rate at which incidence of COVID-19 cases, and associated hospitalisations and deaths, could increase will depend on the effectiveness of the control measures that remain in place and on the extent to which people change their behaviour in comparison to the pre-COVID-19 era:

  • If people are more cautious, having learned about the risks of the disease or if they are instructed to change their behaviour (e.g. by wearing masks), the transmission rate would be lower than before measures were introduced.
  • However, the progressive lifting of the prohibition of mass gatherings may lead to some people meeting in larger numbers.
  • Furthermore, the proportion of infections requiring hospitalisation or ICU care may be lower if older people and those who belong to risk groups restrict their contact rates to a greater extent than the general population following the phasing out of measures.

In summary, the probability of the risk of COVID-19 incidence rising to levels that require stricter response measures, as a consequence of lifting/adjusting community level physical distancing measures ranges from moderate (if measures are phased out gradually, when only sporadic or cluster transmission is reported, and when appropriate monitoring systems and capacities for extensive testing and contact tracing are in place) to very high (if measures are phased out when there is still ongoing community transmission, and no appropriate monitoring systems and capacities for extensive testing and contact tracing are in place).

An increase in COVID-19 incidence would be associated with increasing morbidity and mortality, with more severe morbidity and mortality likely if individuals at increased risk of severe outcome are not properly shielded. Such an increase, if not checked rapidly, may place healthcare systems under stress, as was seen in March and April 2020

in several EU/EEA countries and the UK. However, a set of control measures are now known to be effective in checking and reversing the trend towards increasing incidence within a period of about two-to-three weeks.

Therefore, the impact of COVID-19 incidence rising is assessed as moderate.

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