Page 8
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. What is the risk of occurrence of widespread national community transmission of COVID-19 in the EU/EEA and UK in the coming weeks? 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: · 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. · 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. What is the risk of healthcare system capacity being exceeded in the EU/EEA and the UK in the coming weeks? 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: · 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. · 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 [54]. · 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. · 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