The risk of severe disease associated with COVID-19 infection for people in the EU/EEA and UK is currently considered moderate for the general population and high for older adults and individuals with chronic underlying conditions. In addition, the risk of milder disease, and the consequent impact on social and work-related activity, is considered high.
This assessment is based on the following factors:
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There is an increasing number of cases in several EU/EEA countries without epidemiological links to explain the source of transmission. In some countries, transmission within healthcare settings has been reported affecting healthcare workers. As reported cases increase globally in a growing number of countries (found here), the likelihood of continued introductions into and between EU/EEA countries will increase. Given these factors, the probability of further transmission in the EU/EEA and the UK is considered very high. The speed with which COVID-19 can cause nationally incapacitating epidemics once transmission within the community is established indicates that it is likely that in a few weeks or even days, similar situations to those seen in China and Italy may be seen in other EU/EEA countries or the UK, as more countries report evidence of community transmission.
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The evidence from analyses of cases to date is that COVID-19 infection causes mild disease (i.e. non-pneumonia or mild pneumonia) in about 80% of cases and most cases recover, 14% develop more severe disease and 6% experience critical illness. Severe illness and death is more common among the elderly and those with other chronic underlying conditions, with these risk groups accounting for the majority of severe disease and fatalities to date. In the event of a disruption of healthcare services, the impact could be very high. In addition to the public health impact with substantial fatal outcomes in high-risk groups, COVID-19 outbreaks can cause huge economic and societal disruptions.
The risk of the occurrence of subnational community transmission of COVID-19 in the EU/EEA and the UK is currently considered very high.
This assessment is based on the following factors:
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Several events already reported in Europe indicate that local transmission may have resulted in several sub-national clusters. The accumulated evidence from clusters reported in the EU/EEA and the UK indicates that once imported, the virus causing COVID-19 can be transmitted rapidly. It is plausible that a proportion of transmissions occur from cases with mild symptoms that do not provoke healthcare-seeking behaviour. The increase in case numbers and the number of countries reporting those cases globally increases the potential routes of importation of the infection into and between countries in the EU/EEA and the UK. The likelihood of this occurring depends on the speed of detection of local transmission and whether effective response measures are applied early enough at-scale. Early evidence from several settings globally indicates that rigorous public health measures, particularly related to isolation and social distancing, implemented immediately after identifying cases can reduce but does not exclude the probability of further spread.
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The impact of such clusters in local areas would be high, but would depend on national capacity to organise surge capacity across regions. The impact would be especially high if hospitals are affected and a large number of healthcare workers need to be isolated or become infected. The impact on vulnerable groups in the affected hospitals or healthcare facilities would be severe, in particular for the elderly.
The risk of occurrence of widespread national community transmission of COVID-19 in the EU/EEA and the UK in the coming weeks is high.
This assessment is based on the following factors:
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There is an increasing number of countries with local community transmission around the world and in Europe, and a growing number of areas reporting local sub-national community transmission. Exportations have caused transmission in previously unaffected areas. The control measures have, up to now, only been able to slow the further spread, but not to stop it. If numerous local sub-national clusters of community transmission arise simultaneously, they could merge into a situation of widespread national community transmission. The likelihood of this occurring depends on the speed of detection of local transmission and whether effective response measures are applied early enough and at-scale. Early evidence from several settings globally indicates that rigorous public health measures, particularly related to isolation and social distancing, implemented immediately after identifying cases can reduce but does not exclude the probability of further spread. Evidence to-date from China, and emerging evidence from Korea, indicates that early decisive actions may reduce community transmission.
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The impact of national community transmission would be high, especially if hospitals are affected and a large number of healthcare workers need to be isolated or become infected. The impact on vulnerable groups in the affected hospitals or healthcare facilities would be severe, in particular for the elderly.
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:
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As the number of reported COVID-19 cases in the EU/EEA and the UK has increased in the last 10 days, very quickly in several EU/EEA countries, the probability of increased clusters in local areas and increased widespread community transmission is considered high. Analyses carried out by ECDC indicate that if the pandemic progresses on its current course without strong countermeasures or surge capacity enacted, that most EU/EEA countries will far exceed the available ICU capacity they currently have available by the end of March.
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Influenza season is still ongoing, creating a heavy burden on ICUs, however, EU/EEA countries might have already moved past the peak period of high influenza circulation and countries reporting hospital data saw a declining number of hospitalisations due to influenza over the last few weeks. This allows for some optimism regarding the availability of ICU beds, although the mean duration of ICU hospitalisation for influenza is around 10 days. For the latest influenza update see the joint ECDC–WHO/Europe weekly influenza update.
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The continued pattern of increase in COVID-19 cases is very similar to that of Hubei province in mid- and late-January 2020. If the increase continues, in the absence of the application of mitigation measures, the potential impact on the public health and overall healthcare systems would be high. Increasing numbers of imported cases from other EU countries and local transmission chains require substantially more resources, i.e. staff for case management, surveillance, and contact tracing, which in some countries is beginning to or already has overstretched public healthcare systems. Risk communication to concerned members of the public and healthcare professionals continues to demand significant and growing staff resources. As testing needs for COVID-19 increase, some laboratories are reporting crucial shortages affecting diagnostic capacity for COVID-19 and other laboratory services. Further increased transmission could result in a significant increase of hospital admissions at a time when healthcare systems may already be under pressure from the current influenza season. Several parts of Italy have already reported healthcare system saturation due to very high patient loads requiring intensive care. Already stretched capacity would be further exacerbated if substantial numbers of healthcare workers became infected with COVID-19. The impact of increased pressure on the health system introduced by COVID-19 is dependent on the level of preparedness and surge capacity that a given country or area has enacted or can quickly enact.
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While it is likely not feasible to stop the spread of COVID-19 in the EU/EEA, it is essential to introduce measures to slow down the spread of the virus in the population in order to allow healthcare systems to put in place surge capacity measures to absorb more severe COVID-19 cases. These options are listed under ‘Options for response’ and recent ECDC guidance documents. The implementation of these mitigation measures will determine the eventual level of impact of the epidemic on health system capacity.
The risk associated with transmission of COVID-19 in health and social institutions with large vulnerable populations is considered high.
This assessment is based on the following factors:
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The number of reported COVID-19 cases in the EU/EEA and the UK has increased in the last 10 days, very quickly in several EU/EEA countries, and the probability of increased clusters in local areas is considered high. In some settings, transmission within healthcare settings, including long-term care facilities has been reported. It is plausible that a proportion of transmissions occur from cases with mild symptoms that do not provoke healthcare-seeking behaviour, however these cases can still transmit the virus. If health and social institutions are exposed to the virus by health workers or family members with mild infection, the virus could spread quickly in such a setting, in the absence of very early detection and highly effective infection control. The probability of transmission in such settings can be modified by the level of implementation of robust IPC measures and early detection and isolation of introduced cases in patients, residents or staff.
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The great majority of the most severe illnesses and deaths have occurred among the elderly and those with other chronic underlying conditions. Thus, the impact on vulnerable groups in affected hospitals or healthcare facilities would be severe, in particular for the elderly. The impact would be especially high if a large number of healthcare or social care workers need to be isolated or become infected.