While the European Commission has chosen to postpone its roadmap on the lifting of restrictive measures to meet the request of some Member States, the European Centre for Disease Prevention and Control (ECDC) published, on Wednesday 8 April, its eighth rapid risk assessment of COVID-19, in which it considers it “premature” to relax the measures in force.
The Advisory Panel on COVID-19, meanwhile, at its last meeting on 5 April, discussed criteria, but did not go much further, according to a report published three days later.
After similar announcements made by Austria, Denmark and the Czech Republic earlier this week, Poland announced on Thursday 9 April, without further details, that it would consider “easing certain restrictions (...) after Easter” (see EUROPE 12464/5).
ECDC evaluation: peak has not yet been reached
The European Centre for Disease Prevention and Control delivered a new risk analysis of COVID-19. According to it, despite encouraging signs in Italy and Austria, where the number of deaths is declining, “there is currently no indication at EU and EEA level that the peak of the epidemic has been reached”. Furthermore: “Current estimates suggest that no EU/EEA country is close to reaching the necessary level of population protection, which means that sustained transmission of the virus can be expected if current interventions are lifted too quickly”.
In this context, the EU agency notes that “it is currently too early to start lifting all community and physical distancing measures in the EU/EEA and the UK”. All the more so as the data collected must be analysed with a certain hindsight: reported new infections on any given day reflect the measures that were in place around one week earlier, while the deaths reported on any given day reflect the epidemiological situation and measures in place two to three weeks earlier. “This delay complicates the assessment of the impact of the measures and can present a particular challenge when communicating to the public the need to maintain current restrictions and measures”, notes the ECDC.
And to conclude: in the absence of a vaccine, physical distancing measures of some kind will therefore need to remain in place for at least some months, in order to ensure that demand for healthcare does not exceed availability. “Before considering the lifting of any measures, Member States should ensure enhanced population and hospital-based testing and surveillance systems are in place to inform and monitor escalation/de-escalation strategies and assess the epidemiological consequences”. The ECDC underlines that solidarity and coordination between Member States will remain essential in the de-escalation phase in order to increase the effect of measures taken and minimise the risk of infection ‘spill-over’ between countries if they de-escalate at different rates and in different ways.
Epidemiological and operational criteria, according to the advisory panel
The Advisory Panel on COVID-19, made up of eight experts who are supposed to advise the Commission in the face of this crisis, has not yet really taken a position on the timetable for ending the crisis. At its meeting on 5 April, the Panel merely called for a set of criteria to be taken into account when considering the lifting of the restrictive measures. The minutes of the meeting discussed epidemiological criteria, such as ICU capacity and operational criteria, testing capacity and strategy (diagnosis and serological) and contact tracing capacity (including the possible use of apps).
The experts stress the importance of communicating clearly to the public that the phase following the lifting of the measures will not amount to a return to normality. “The virus is now part of our lives and we have to adapt to it”, the document says.
ECDC raises the level of risk of hospital overcrowding
The ECDC's risk assessment is broader than just the issue of exit strategies. If the centre keeps the main markers at the same stage, it raises the risk of saturation by one level. It now says that the risk of health and social care system capacity in the EU/EEA and the UK being exceeded in the coming weeks is considered “high” with mitigation measures in place and “very high” if insufficient mitigation measures are in place. Previously, it only talked about a “high” risk.
According to the ECDC, pressure on health and social care systems and health care workers continues with reported shortages in laboratory and testing capacity, personal protective equipment and healthcare capacity (including ventilators in intensive care units and healthcare worker capacity). Healthcare workers are particularly vulnerable in this crisis: in several EU/EEA countries for which data are available, between 9% and 26% of all diagnosed COVID-19 cases involve healthcare professionals.
For the rest, recent EU/EEA data show that 32% of diagnosed cases required hospitalisation and 2.4% have had severe illness requiring respiratory support and/or ventilation. The crude fatality rate was 1.5% among diagnosed cases and 11% among hospitalised cases.
The ECDC concludes: in the current situation, a strong focus should remain on comprehensive testing and surveillance strategies (including contact tracing), community measures (including physical distancing), strengthening of healthcare systems and informing the public and health community.
Advisory Panel document: https://bit.ly/3c8fTxF and ECDC analysis: https://bit.ly/2Rpk5Bz (Original version in French by Sophie Petitjean)