Risk assessment: Outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): increased transmission beyond China – fourth update

Risk assessment
Citation Link

European Centre for Disease Prevention and Control. Outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): increased transmission beyond China - fourth update, 14 February 2020. ECDC: Stockholm; 2020.

Copy citation to clipboard

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, which is phylogenetically in the SARS-CoV clade. The novel coronavirus has thus been named ‘severe acute respiratory syndrome coronavirus 2’ (SARS-CoV-2), while coronavirus disease associated with it is now referred to as COVID-19.

Executive summary

As of 13 February 2020, 9:00, more than 60 330 cases of COVID-19 have been reported worldwide, mainly in China and from all Chinese provinces; of these cases, more than 450 cases were reported from other countries. As of 13 February, 13 countries reported local transmission: the United Arab Emirates, Canada, France, Germany, Japan, Malaysia, South Korea, Singapore, Taiwan, Thailand, the United Kingdom, the United States of America and Vietnam.

In the EU/EEA and the UK, 44 cases have been reported as of 13 February. Among them, 21 are locally acquired: Germany (14), France (6) and the UK (1). All of these cases have epidemiological links to earlier identified clusters with importations from outside the EU/EEA and the UK.

See updates on the epidemiology of SARS-CoV-2.

According to available evidence, the transmissibility of this virus is assessed as sufficient for sustained community transmission. Further cases and deaths in China are expected in the coming days and weeks. Further cases or clusters are also expected from other countries that are already reporting increasing numbers of cases, including community transmission. Therefore, health authorities in the EU/EEA and the UK should remain vigilant and strengthen their capacity to respond to possible importation of cases from China or, potentially, other areas with presumed ongoing community transmission; increase their capacity for surveillance and review their pandemic preparedness plans.

There are considerable uncertainties in assessing the risk of this event, due to lack of detailed epidemiological analyses.

ECDC assesses the risk based on the probability of transmission and the impact of the disease. On the basis of the information currently available, the Centre’s assessment is as follows:


  • The risk for healthcare systems capacity in the EU/EEA and the UK that would arise in the face of widespreadtransmission of SARS-CoV-2 at the peak of the influenza season is considered to be low to moderate.
  • The risk associated with SARS-CoV-2 infection for the EU/EEA and UK population is currently low.
  • The risk for people from the EU/EEA/UK travelling/resident in areas with presumed community transmissionis currently high.

What is new in this update

  • Updated number of cases in and beyond China
  • Description of cases and transmission reported in the EU/EEA and the UK
  • Findings on disease and transmissibility from recent studies
  • Risk to the healthcare systems in the EU/EEA and the UK
  • Risk to citizens from the EU/EEA and UK travelling or living in areas with presumed community transmission
  • ECDC guidance documents (listed under ‘Options for response’).

Latest updates


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

Risk assessment -


Infection prevention and control and preparedness for COVID-19 in healthcare settings

Technical report -


Infection prevention and control in the household management of people with suspected or confirmed coronavirus disease (COVID-19)

Technical report -


Download today’s data on the geographic distribution of COVID-19 cases worldwide

Table -


Contact tracing: Public health management of persons, including healthcare workers, having had contact with COVID-19 cases in the European Union – second update

Technical report -

More on this topic

Risk assessment on COVID-19, 25 March 2020

ECDC risk assessments aim at supporting the EU/EEA countries and the European Commission in their preparedness and response to a public health threat. They provide a timely summary and risk assessment of a public health threat for EU/EEA countries related to a specific event. They also include potential options for response

Case definition and European surveillance for COVID-19, as of 2 March 2020

Case definition for EU surveillance of COVID-19. A case definition is a set of standard criteria for classifying whether a person has a particular disease, syndrome, or other health condition.


Guidelines for the use of non-pharmaceutical measures to delay and mitigate the impact of 2019-nCoV

Technical report -

This document provides guidance on the application of non-pharmaceutical countermeasures to minimise the spread of the 2019 novel coronavirus (2019-nCoV) in the population. Some of the measures proposed refer specifically to certain phases of the epidemic (containment or mitigation phases), and can be adapted depending on the assessed severity/impact of the infection. Other measures are valid for all phases of an epidemic.


Health emergency preparedness for imported cases of high-consequence infectious diseases

Technical report -

To support countries in the European Union/European Economic Area (EU/EEA) in their review of preparedness system planning, ECDC launches an operational checklist for health emergency preparedness for imported cases of high consequence infectious diseases.


Infection prevention and control for the care of patients with 2019-nCoV in healthcare settings

Technical report -

This document aims to provide guidance to EU/EEA healthcare facilities and healthcare providers on infection prevention and control measures during the management of suspected and confirmed cases of 2019-nCoV infection.


Personal protective equipment (PPE) needs in healthcare settings for the care of patients with suspected or confirmed novel coronavirus (2019-nCoV)

Technical report -

The aim of this document is to support public health preparedness planning with regard to personal protective equipment (PPE) needs in healthcare settings where patients suspected or confirmed to have been infected with the novel coronavirus 2019-nCoV are being treated.


Interim guidance for environmental cleaning in non-healthcare facilities exposed to SARS-CoV-2

Technical report -

This document aims to provide guidance about the environmental cleaning in non-healthcare facilities (e.g. rooms, public offices, transports, schools, etc.) where confirmed COVID-19 cases have been before being admitted to hospital. This guidance is based on the current knowledge about SARS-CoV-2 and evidence originating from studies on other coronaviruses.


Safe use of personal protective equipment in the treatment of infectious diseases of high consequence

Technical guidance, Tutorial -

This ECDC tutorial provides practical information on the proper use of PPE at the point of care, including technical requirements and procurement aspects.

Areas with presumed community transmission of COVID-19

As of 2 March 2020, ECDC no longer defines areas of presumed community transmission. Please refer to WHO situation reports for country classification [hyperlink: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/