Risk assessment on COVID-19, 24 September 2020

Given the increase in notification rates observed in the EU/EEA and the UK, what risk does the COVID-19 pandemic pose to the general population, vulnerable individuals, and COVID-19 healthcare provision? 

Countries are currently experiencing different epidemiologic patterns which pose different risks and require targeted interventions.

Based on recent epidemiological information, it is possible to categorise EU/EEA countries and the UK as observing either ‘stable trends’ or ‘concerning trends’. The latter group is defined here as those that meet any two of the following criteria:

• high (≥ 60/100 000) or sustained increase (≥7 days) in 14-day case notification rates
• high (≥60/100 000) or sustained increase (≥7 days) in 14-day case notification rates in older age groups (65-79 years old AND/OR 80 years or older)
• high (≥ 3%) or sustained increase (≥7 days) in test positivity
• high (≥ 10/1 000 000) or sustained increase (≥7 days) in 14-day death rates.

The definition of trends and threshold used in the criteria above are available in the ECDC Weekly COVID-19 country overview report.

Countries with stable trends

As per 13 September, the EU/EEA countries with a stable trend include Belgium, Cyprus, Finland, Germany, Greece, Iceland, Italy, Latvia, Liechtenstein, Lithuania, Poland and Sweden. In these countries, the overall probability of infection is assessed as low. Because of the low proportion of cases in elderly individuals, and the current low proportion of severe cases and low death notification rates, the impact of the disease is assessed as low. At this time, there is an overall low risk of COVID-19 for the general population and the healthcare system in these countries. Regarding vulnerable individuals (individuals with risk factors for severe COVID-19 disease, such as the elderly), since the impact of the disease in these groups is very high, the overall risk is moderate.

Close monitoring of the evolving epidemiological situation, including infections detected at the primary care level, the level of occupancy of hospital and ICU beds and the spread of infections amongst vulnerable individuals, for whom the impact of COVID-19 is very high, are key to avoid a rapid increase in the risk level in the coming weeks.

Countries with concerning trends

As per 13 September, the other group includes all the remaining EU/EEA countries and the UK. The increased notification rates may be partially explained by the steady increase in testing rates that occurred in recent weeks and months (e.g. Luxembourg, Denmark and the UK) as well as by the larger number of young, mild or even asymptomatic cases that have been tested. However, due to the high volume of transmission, it appears that the non-pharmaceutical interventions (NPI) in place have not been effective in limiting significant increase of infection, either because adherence to the measures may not be optimal or the measures in place may not be sufficient to reduce or control exposure. In addition, available data from seroprevalence studies suggest that the level of immunity in the population is <15% in most areas within the EU/EEA and the UK, and, since a vaccine will not be available in the short-term, the vulnerability of the population to infection remains high. Based on this, in these countries the overall probability of infection is very high.

These countries with concerning trends can be placed into two sub-groups. One sub-group includes those countries where high and increasing notification rates are reported due to high testing rates, and transmission is reported primarily in young individuals, with a low proportion of severe cases and low death notification rates (<10/1 000 000). This sub-group includes Austria, Denmark, Estonia, France, Ireland, Luxembourg, the Netherlands, Norway, Portugal, Slovakia, Slovenia and the United Kingdom. Since severe COVID-19 and death is more common among vulnerable individuals and these groups are currently less affected than other groups, the impact of the disease is still low. This gives an overall moderate risk of COVID-19 for the general population and for healthcare provision. However, it should be noted that with a high volume of transmission continuing over the course of several weeks, shielding of vulnerable individuals becomes challenging, and since the impact of the disease in these groups is very high, the risk for this population remains very high. In addition, the number of hospitalised patients and severe cases will inevitably increase as some patients <65 years of age will also need hospitalisation and ICU care, although at lower proportions than older patients, with a consequent stress to healthcare provision.

The second sub-group includes countries with trends of high concern, i.e. with high or increasing notification rates in older cases and, consequently, an increased proportion of hospitalised and severe cases. In these countries, increasing or high death notification rates are already observed (as of 13 September, in Bulgaria, Croatia, Czechia, Hungary, Malta, Romania and Spain), or may be observed soon. In some local/regional areas of these countries, healthcare provision is already under pressure, with high hospital and ICU bed occupancy rates and high levels of fatigue among healthcare workers. The improvements that have been made in case management, supportive treatment and care are still not enough to avoid severe disease and death in a large proportion of vulnerable patients. Implementing stricter NPIs, which proved to be effective in controlling the epidemic in all EU/EEA countries and the UK in spring 2020, appears to be the only available strategy that may be able to ensure a moderate (as opposed to high) impact of the disease on individuals and on healthcare provision. Therefore, in these countries, even with a timely and strict implementation of NPIs, the overall risk of COVID-19 is assessed as high for the general population and very high for vulnerable individuals.